Efficacy of Argon Plasma Coagulation for Endoscopic Hemostasis and Rebleeding in Peptic Ulcer disease: A Systematic Review and Meta-Analysis

Aims Endoscopic hemostasis is first-line therapy in managing peptic ulcer bleeding (PUB) with high-risk stigmata (Forrest classification Ia, Ib, IIa). While argon plasma coagulation (APC) is widely available there are limited studies with a limited number of patients evaluating its efficacy in PUB. Thus, by current guidelines, APC has yet to be definitively recommended as endoscopic hemostasis for PUB. This meta-analysis evaluates the effectiveness of APC in high risk PUB in achieving initial hemostasis and preventing rebleeding, comparing its performance to other standard endoscopic hemostasis modalities

Methods We performed a systematic literature search of PubMed, Embase, Web of Science, and Scopus to identify studies up to October 2024, evaluating APC versus alternative endoscopic hemostasis modalities for high-risk PUB. Eligible studies included those reporting on initial hemostasis and rebleeding outcomes. Two reviewers (KS, IMG) independently screened studies and extracted data, resolving discrepancies by consensus. Quality assessments were conducted using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random-effects model to account for study heterogeneity, quantified by I² statistics

Results Fourteen studies met inclusion criteria (7 observational and 7 RCTs), with pooled sample sizes of n=816 and n=975 respectively. Meta-analysis of all studies showed that for the outcome of initial hemostasis, the pooled OR was 1.01 (95% CI: 0.39–2.62, p=0.976), demonstrating no significant difference between APC and other endoscopic treatments. Similarly, rebleeding rates showed no significant difference (pooled OR: 1.12; 95% CI: 0.69–1.83, p=0.636). When we limited our meta-analysis to only the 6 RCTs with an active hemostasis treatment control group, we again found similar results for both outcomes of initial hemostasis and rebleeding. Moderate heterogeneity of studies was observed in rebleeding rates (I²=47.6%) and high heterogeneity for initial hemostasis (I²=84.6%) [1] [2] [3].

Conclusions APC appears comparable and non-inferior to other standard of care endoscopic hemostasis modalities in achieving initial hemostasis and preventing rebleeding in high-risk PUB. Updated guidelines will need to re-evaluate and decide where APC fits in with endoscopic hemostasis of high-risk PUB.

Publication History

Article published online:
27 March 2025

• References

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