OPTIMAL EPINEPHRINE INJECTION VOLUME FOR ENDOSCOPIC TREATMENT OF ACUTE PEPTIC ULCER BLEEDING. A SYSTEMATIC REVIEW AND META-ANALYSIS.
Notice bibliographique
Résumé
Artificial intelligence: The authors declare that they did not use artificial intelligence (AI) or any AI-assisted technologies in the elaboration of the article. Lay summaryPeptic ulcers can sometimes bleed suddenly and severely, and this can be lifethreatening.Doctors often stop this bleeding using an endoscope, a small camera that allows treatment from inside the stomach.One of the most common treatments is injecting a medicine called epinephrine directly into the ulcer to help stop the bleeding.However, it has not been clear how much epinephrine should be injected for the best and safest results.In this study, we reviewed all high-quality clinical trials that compared different amounts of epinephrine injection for treating bleeding ulcers.Data from four studies involving 556 patients were analyzed.We found that using larger volumes of epinephrine was more effective at stopping the bleeding permanently than using smaller volumes.However, patients who received larger injections also had more side effects, mostly abdominal pain.Serious complications were rare but occurred only when very high volumes (more than 35 cc) were used.Overall, injecting up to 30 cc of epinephrine appears to be both safe and more effective than using smaller amounts for this type of bleeding.More research is needed to determine the best volume when epinephrine is used together with other endoscopic treatments. ABSTRACT Introduction: endoscopic treatment improves the outcomes of patients with acute peptic ulcer bleeding (APUB). Epinephrine injection is a frequently used treatment.There is no consensus, however, on the optimal volume of epinephrine injection.The primary aim of this study was to compare the efficacy and safety of endoscopic injection using different volumes of epinephrine for APUB treatment in a systematic review and meta-analysis.Methods: systematic searches were performed for full articles published from 1986 until January 2025 in multiple databases.We included randomized controlled trials (RCT) comparing different epinephrine volumes injection.Primary outcome was permanent hemostasis defined as achieved initial hemostasis and not rebleeding during admission.Secondary outcomes were adverse events (AE), need for rescue treatment and mortality.We estimated the odds ratio (OR) and 95 % confidence interval (CI) using random-effects models.Results: four RCT including 556 patients were analyzed and no studies comparing different doses of epinephrine in combination therapy were found.In studies comparing different doses of epinephrine alone, permanent hemostasis was more frequently achieved in the large-volume injection groups (91 % vs 77 %, OR: 2.90; 95 % CI: 1.72-4.86,p < 0.0001).AE were also more frequent in the large-volume groups (33 % vs 3 %, OR: 21.02; 95 % CI: 6.51-67.87,p < 0.0001).Abdominal pain was the most frequent AE.Bowel perforation appeared only when injection volumes exceeded 35 cc.Conclusion: endoscopic injection of large volumes of epinephrine up to 30 cc appear safe and improve rates of permanent hemostasis when compared to lower injection volume in patients with APUB.Trials assessing the use of larger epinephrine volume in combination endoscopic hemostatic therapy are needed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,019 | 0,034 |
| Bibliométrie | 0,006 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».