Medical Resident Robert Wood Johnson Medical School, Rutgers University New Brunswick, NJ
Abhishek Bhurwal, MBBS, MD1, Hemant Mutneja, MBBS, MD2, Anish V. Patel, MD1, Emmanuel Palomerat, MD2, Lauren Pioppo, MD1, Augustine Tawadros, MD1, Ishani Shah, MD3, Akshay Goel, MBBS, MD4, Khwaja F. Haq, MD5, Bhaumik Brahmbhatt, MBBS6; 1Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; 2John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 3Creighton University Arizona Health Education Alliance, Phoenix, AZ; 4University of Arkansas for Medical Sciences, New Brunswick, NJ; 5Henry Ford Hospital/Wayne State University, Detroit, MI; 6Mayo Clinic, Jacksonville, FL
Introduction: Forrest classification for ulceration has significant intra and inter-observer variability. The endoscopic doppler probe (DOP-US) identifies arterial blood flow at the base to direct therapy. To the best of our knowledge, the efficacy of DOP-US in decreasing peptic ulcer rebleeding has not been systematically evaluated. We performed the first systematic review and meta-analysis to evaluate the role of the DOP-US in bleeding peptic ulcers. Methods: Three reviewers independently and in duplicate searched PubMed, Medline, CENTRAL, EMBASE, Scopus, Web of Sciences and clinical trial registries from inception until December 2019 evaluating the use of through the scope doppler probe in peptic ulcer bleeding using key words such as “doppler endoscopic probe”, “through the scope doppler”, “peptic ulcer”, “non-ultrasound probe”, “doppler US”, “gastroduodenal ulcers”. Primary outcomes were the overall rebleeding rate with the use of DOP-US probe and comparison of rebleeding rate in patients with DOP-US versus standard visual evaluation. The specific inclusion criteria for the systematic review and meta-analysis were: (1) all Randomized Control Trials (RCTs) or prospective studies or retrospective studies in patients more than 18 years of age with peptic ulcer related hemorrhage (2) use of through-the-scope DOP-US as intervention for management of upper gastrointestinal bleeding before endoscopic intervention to risk stratify lesions (3) full text articles available in English language. Results: Seven studies were included after a thorough search was concluded using the key words. This yielded a total of 723 patients included in the analysis with a total of 576 patients undergoing DEP evaluation to guide endoscopic therapy. The pooled analysis of studies using DOP-US prior to endoscopic therapy revealed an overall rebleeding rate of 7.6% (95% Confidence interval (CI) 4.8-11.8%). Rebleeding Rate are significantly lower with the use of DOP-US as compared to visual evaluation alone (OR 0.34,95% CI 0.18-0.66; p=0.001). Further studies are needed as the total included studies were less than ten and publication bias cannot be accurately ascertained. Discussion: The first systematic review and meta-analysis showed that the DOP-US is a beneficial tool in the management of bleeding ulcers and adds valuable information to visual evaluation.
Disclosures: Abhishek Bhurwal indicated no relevant financial relationships. Hemant Mutneja indicated no relevant financial relationships. Anish Patel indicated no relevant financial relationships. Emmanuel Palomerat indicated no relevant financial relationships. Lauren Pioppo indicated no relevant financial relationships. Augustine Tawadros indicated no relevant financial relationships. Ishani Shah indicated no relevant financial relationships. Akshay Goel indicated no relevant financial relationships. Khwaja Haq indicated no relevant financial relationships. Bhaumik Brahmbhatt indicated no relevant financial relationships.