Evidence-based Analysis of Somatostatin and Its Analogues Combined with Proton Pump Inhibitor for Acute Non-variceal Upper Gastrointestinal Bleeding

OBJECTIVE To systematically review the effectiveness and safety of somatostatin and its analogues combined with proton pump inhibitor(PPI) for acute non-variceal upper gastrointestinal bleeding(ANVUGIB), and evaluate the cost-effectiveness of the two groups. METHODS Evidence-based medicine method was used to collect random clinical controlled trials(RCTs) and cohort studies for the treatment of ANVUGIB with somatostatin and its analogues combined with PPI. Meta analysis was performed to obtain analysis results of effectiveness and safety, and cost-effectiveness analysis was performed. RESULTS A total of six RCTs involving 610 patients were included. The results of meta-analysis showed that the treatment of somatostatin and its analogues combined with high, medium and low doses of PPI was superior to PPI treatment in the following aspects, the difference was statistically significant:total effective rateOR=3.34, 95%CI(2.03, 5.47), P<0.000 01, hemostasis timeMD=-9.04, 95%CI(-11.69, -6.38), P<0.000 01, blood transfusionMD=-1.10, 95%CI(-1.46, -0.74), P<0.000 01. While there was no significant difference in the incidence of adverse events between two groupsOR=0.49, 95%CI(0.11, 2.12), P=0.34. And the cost-effectiveness analysis of somatostatin combined with high, medium and low doses of omeprazole to high, medium and low doses of omeprazole in patients with ANVUGIB were performed respectively. The incremental cost-effectiveness ratio were 172.28, 217.26, 330.37, respectively. Sensitivity analysis showed that the results were stable. The use of somatostatin and its analogues in combination with PPI after endoscopic hemostasis was only a cohort study. The results showed that the combination therapy after endoscopic hemostasis was not superior to PPI monotherapy. CONCLUSION Current evidence indicates that, somatostatin and its analogues combined with PPI is more effective scheme without endoscopic therapy. Both treatments are safe and well tolerated. Considering the direct cost of drugs, the high-dose PPI combined therapy is more cost-effectiveness than the medium-dose and the low-dose PPI combined therapy. And PPI can be considered for patients undergoing endoscopic hemostasis because both are effective.