Role of the endoscopic Doppler probe in nonvariceal upper gastrointestinal bleeding: Systematic review and meta‐analysis

Objectives The effectiveness of the Doppler endoscopic probe (DEP) remains unclear in nonvariceal upper gastrointestinal bleeding (NVUGIB). We thus performed a systematic review characterizing the effectiveness of DEP in patients with NVUGIB addressing this question. Methods A literature search was done until July 2021 using MEDLINE, EMBASE, and ISI Web of Science. A series of meta‐analyses were performed assessing outcomes among observational and interventional studies for DEP signal positive and negative lesions as well as DEP‐assisted versus standard endoscopies. The primary outcome was “overall rebleeding”; secondary outcomes included all‐cause mortality, bleeding‐related mortality, need for surgery, length of stay, intensive care unit stay, and angiography. Results Fourteen studies were included from 1911 citations identified. Observational studies compared bleeding lesions with DEP‐positive versus DEP‐negative signals (11 studies, n = 800 prehemostasis; five studies, n = 148 with posthemostasis data). Three interventional studies (n = 308) compared DEP‐assisted to standard endoscopy management. DEP signal positive versus negative lesions either prior to or following any possible hemostasis were at greater risk of overall rebleeding (odds ratio [OR] 6.54 [2.36, 18.11] and OR 25.96 [6.74, 100.0], respectively). The use of DEP during upper endoscopy significantly reduced overall rebleeding rates (OR 0.27 [0.14, 0.54]). When removing outcomes analysis for which only one study was available, all evaluable outcomes were improved with DEP characterization of management guidance except for all‐cause mortality. Conclusion Although with low certainty evidence, DEP‐related information improves on sole visual prediction of rebleeding in NVUGIB, with DEP‐guided management yielding decreased overall rebleeding, bleeding‐related mortality, and need for surgery.