The role of endoscopic doppler probe in the management of bleeding peptic ulcers: a systematic review and meta-analysis

ABSTRACT

Objectives

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. We performed a systematic review and meta-analysis to evaluate the role of the DOP-US in bleeding peptic ulcers.

Methods

Three independent reviewers performed a comprehensive review of all original articles published from inception to December 2019, evaluating the use of DOP-US in peptic ulcer bleeding. Primary outcomes were the comparison of rebleeding rate, mortality, and surgical intervention in patients with DOP-US signal-guided therapy versus standard visual evaluation guided therapy.

Results

Eight studies were included after a thorough search was concluded using the key words. The use of DOP-US probe decreases rebleeding, mortality, and surgical intervention as compared to Forrest Classification. The risk of rebleeding is significantly higher if the signal persists despite endoscopic therapy (48.5% (95% CI 29.5–67.9%)).

Conclusion

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.

KEYWORDS:

• Peptic ulcer disease
• risk stratification
• rebleeding
• endoscopic doppler probe

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One reviewer would like to disclose that they are a consultant for Medtronic. All other peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

A. Bhurwal, A. Patel, H. Mutneja and E.P. Tajeda designed the study. All authors participated in the search strategy and evaluated the articles for eligibility in the meta-analysis. A. Bhurwal and H. Mutneja performed the statistical analysis. A. Bhurwal, H. Mutneja, and A. Goel wrote the manuscript. All authors edited the manuscript and gave approval for the final version.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.