Effectiveness and safety of epinephrine and norepinephrine for treating non-variceal upper gastrointestinal bleeding: a meta-analysis / 中华消化内镜杂志

ABSTRACT

Objective:To systematically evaluate the effectiveness and safety of epinephrine injection and norepinephrine spraying for treating non-variceal upper gastrointestinal bleeding.Methods:Databases including the PubMed, Embase, Cochrane Library, CNKI, CBM, VIP and WanFang Data with the retrieval time from inception to December 2018 were searched to collect the related clinical trials. The references of included studies were also retrieved. Studies were screened, data were extracted, and the risk of bias was assessed by 2 reviewers separately. The meta-analysis was conducted by using RevMan 5.3 software. The grading of recommendations, assessment, development and evaluation (GRADE) quality of evidence system was used to assess the results of meta-analysis.Results:A total of 10 studies involving 884 participants were included. The results showed that compared with the norepinephrine spraying, epinephrine injection was superior in the following aspects with significant differences the effective rate ( RR=1.21, 95% CI 1.12-1.30, P<0.001); the one-week recurrent bleeding rate ( RR=0.28, 95% CI 0.17-0.45, P<0.001); the immediate hemostatic rate ( RR=1.38, 95% CI 1.25-1.52, P<0.001); and the emergent operation rate ( RR=0.35, 95% CI 0.19-0.63, P<0.001). Conclusion:Epinephrine injection is more effective and safer for treating non-variceal upper gastrointestinal bleeding in comparison with norepinephrine spraying.