Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline–epinephrine injection and a combination of the two for the management of bleeding peptic ulcers,☆☆

Presented in part at the annual meeting of the American Society for Gastrointestinal Endoscopy/Digestive Diseases Week 1997, Washington DC, May 11-14, 1997.
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Abstract

Background: The endoscopic hemoclip method is a safe and effective hemostatic method for managing bleeding peptic ulcers. We compared the hemostatic efficacy of the endoscopic hemoclip method with that of hypertonic saline–epinephrine (HSE) injection and a combined method in the management of bleeding peptic ulcers. Methods: From July 1994 to July 1997, we conducted a randomized clinical trial of endoscopic hemostasis involving 124 patients with actively bleeding or visible vessels at endoscopic inspection. Results: Patients were randomly assigned to hemoclip (41 patients), HSE (41 patients), and combined treatment groups (42 patients). Initial hemostasis was achieved in 97.6%, 95.1%, and 97.6% of cases, respectively. Recurrent bleeding developed in 2.4%, 14.6%, and 9.5% of cases. Emergency operations were performed in 4.9%, 14.6%, and 2.3% of cases. The hemostasis rate was 71.4%, 50%, and 66.7% for spurting hemorrhage in each group. Permanent hemostasis was achieved in 95.1%, 85.4%, and 95.2% of cases. Three patients had complications, all in the HSE group. Conclusions: The hemoclip method is an effective hemostatic procedure and is safer than HSE injection. The combined method does not provide substantial advantage over use of the hemoclip method alone in the hemostatic management of bleeding peptic ulcers. (Gastrointest Endosc 1999;49:13-8.)

Section snippets

PATIENTS AND METHODS

Between July 1994 and July 1997, 143 patients with hematemesis or melena who had endoscopic findings of modified Forrest class Ia, Ib, and IIa bleeding activity with a peptic ulcer were admitted to our hospital endoscopy unit. Nineteen patients could not undergo follow-up endoscopic examinations because of personal objections or transfers to other hospitals. The other 124 patients were included in this randomized study.

Within 24 hours of admission, endoscopy with hemostatic techniques was

RESULTS

There was no significant difference in initial mean hemoglobin value: 9.0 g/dL (SD 2.6) for the hemoclip group, 9.1 g/dL (SD 2.8) for the HSE injection therapy group, and 8.9 g/dL (SD 2.0) for the combined therapy group (p = 0.812). There was no significant difference in mean transfusion requirement at admission: 7.4 units (SD 8.4) for the hemoclip group, 7.5 units (SD 8.3) for the HSE injection therapy group, and 10.7 units (SD 14.4) for the combined therapy group (p = 0.935). There were no

DISCUSSION

A variety of endoscopic treatment methods for bleeding peptic ulcers have been tested in trials in many medical centers and in many countries. In general, endoscopic hemostatic methods may be divided into four groups: thermal therapy, regional injection therapy, regional spray methods, and mechanical hemostasis. Each method has both merits and problems related to the hemostatic mechanism and technical procedure itself, and variable results have been reported.

The results of endoscopic hemostatic

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Reprint requests: Il-Kwun Chung, MD, Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Hospital, 23-20 Bongmyung-dong, Chonan City, Choongnam, Republic of Korea 330-100.

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