When living on adrenaline isn’t enough ▸

Despite advances in endoscopic therapy, peptic ulcer bleeding remains common, especially in an increasingly elderly comorbid population. Recurrent bleeding is a major risk factor for mortality and occurs in 10–30% of cases. Many options exist to treat bleeding endoscopically but the optimum methods (or combination of) remain unclear. In this prospective trial, the authors randomised 105 bleeding ulcer patients with active bleeding or high risk stigmata to either combination therapy (epinephrine and haemoclips) or epinephrine alone, outcome measures being rates of initial haemostasis and recurrent bleeding. There was no difference in achieving initial haemostasis (98% and 92%) but bleeding recurred more often in patients treated by epinephrine alone (21%) compared with patients undergoing combination therapy (3.8%, p = 0.008). Among these rebleeders, a second session of combination therapy was much more successful at controlling bleeding than repeated epinephrine. Finally, no patient in the combination group required surgery in contrast with five in the epinephrine group (9%, p = 0.023). Logistic regression revealed that only …