Introduction
Endoscopic hemostasis is first-line therapy in managing peptic ulcer bleeding (PUB) with high-risk stigmata (Forrest classification Ia, Ib, IIa). While argon plasma coagulation (APC) is widely available and easy to use, there are limited studies with a limited number of patients evaluating its efficacy in PUB. This meta-analysis evaluates the effectiveness of APC in high risk PUB in achieving initial hemostasis and preventing rebleeding.
Aims & Methods
We performed a systematic literature search of PubMed, Embase, Web of Science, and Scopus to identify studies up to October 2024, evaluating APC versus alternative endoscopic hemostasis modalities for high-risk PUB. Eligible studies included those reporting on initial hemostasis and rebleeding outcomes. Two reviewers (KS, MO) independently screened studies and extracted data, resolving discrepancies by consensus. Quality assessments were conducted using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random-effects model to account for study heterogeneity, quantified by I^2 statistics.
Results
Fourteen studies met inclusion criteria (7 observational and 7 RCTs), with pooled sample sizes of n=816 and n=975 respectively. Meta-analysis of all studies showed that for the outcome of initial hemostasis, the pooled OR was 1.01 (95% CI: 0.39–2.62, p = 0.976), demonstrating no significant difference between APC and other endoscopic treatments. Similarly, rebleeding rates showed no significant difference (pooled OR: 1.12; 95% CI: 0.69–1.83, p = 0.636). When we limited our meta-analysis to only the 6 RCTs with an active hemostasis treatment control group, we again found similar results for both outcomes of initial hemostasis and rebleeding.
Conclusion
APC appears comparable and non-inferior to other standard of care endoscopic hemostasis modalities in achieving initial hemostasis and preventing rebleeding in high-risk PUB. Updated guidelines will need to re-evaluate and decide where APC fits in with endoscopic hemostasis of high-risk PUB.
References
Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019;171(11):805-22.
Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021;53(3):300-32
Disclosure
Ian Gralnek. has received lecture fees from Astra-Zeneca, Taro Pharma, Vifor Pharma and 3D Matrix. He is also a paid consultant for Boston Scientific, GI View, Motus GI and Symbionix and is a member of the medical advisory board of Motus GI
