Bhurwal Abhishek, Patel Anish, Mutneja Hemant, Goel Akshay, Palomera-Tejeda Emanuel, Brahmbhatt Bhaumik
Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ.
Division of Gastroenterology and Hepatology, John H. Stroger Cook County Hospital, Chicago, Illinois.
Expert Rev Gastroenterol Hepatol. 2021 Jul;15(7):835-843. doi: 10.1080/17474124.2021.1850261. Epub 2020 Dec 14.
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.
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.
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%)).
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.
溃疡的福雷斯特分类法在观察者内和观察者间存在显著差异。内镜多普勒探头（DOP-US）可识别溃疡底部的动脉血流以指导治疗。我们进行了一项系统评价和荟萃分析，以评估DOP-US在消化性溃疡出血中的作用。
三位独立评审员对从开始到2019年12月发表的所有原始文章进行了全面综述，评估DOP-US在消化性溃疡出血中的应用。主要结局是比较DOP-US信号引导治疗与标准视觉评估引导治疗患者的再出血率、死亡率和手术干预情况。
使用关键词进行全面检索后，纳入了八项研究。与福雷斯特分类法相比，使用DOP-US探头可降低再出血率、死亡率和手术干预率。如果内镜治疗后信号持续存在，再出血风险显著更高（48.5%（95%CI 29.5-67.9%））。
首次系统评价和荟萃分析表明，DOP-US是治疗出血性溃疡的有益工具，可为视觉评估提供有价值的信息。
