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☆,☆☆
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
References (21)
- et al.
Endoscopic interventional management of bleeding duodenal and gastric ulcers
Surg Clin North Am
(1992) - et al.
Endoscopic local injection of hypertonic sodium epinephrine (HSE) solution to arrest hemorrhage from upper gastrointestinal tract
Gastrointest Endosc
(1985) - et al.
Endoscopic injection of Adrenalin in bleeding peptic ulcer
Gastrointest Endosc
(1987) - et al.
Prevention of recurrent bleeding from gastric ulcer with a nonbleeding visible vessel by endoscopic injection of absolute ethanol: a prospective, controlled trial
Gastrointest Endosc
(1995) - et al.
Endoscopic injection for the arrest of peptic ulcer hemorrhage: final result of a prospective randomized comparative trial
Gastrointest Endosc
(1993) - et al.
Design of a microwave system for endoscopy: an experimental study of energy, contact and hemostatic efficacy
Gastroenterology
(1993) - et al.
Experimental comparison of endoscopic yttrium-aluminum-garnet laser, electrosurgery and heater probe for canine gut arterial coagulation
Gastroenterology
(1987) - et al.
Controlled trial of endoscopic injection treatment for bleeding from peptic ulcers with visible vessel
Lancet
(1992) - et al.
Injection or heat probe for bleeding ulcer
Gastroenterology
(1991) Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers: a prospective randomized trial
Gastroenterology
(1990)
Cited by (199)
Reply
2023, Clinical Gastroenterology and HepatologyNonvariceal Upper Gastrointestinal Bleeding
2019, Clinical Gastrointestinal EndoscopyOutcomes and Role of Urgent Endoscopy in High-Risk Patients With Acute Nonvariceal Gastrointestinal Bleeding
2018, Clinical Gastroenterology and HepatologyMechanical Hemostasis Techniques in Nonvariceal Upper Gastrointestinal Bleeding
2015, Gastrointestinal Endoscopy Clinics of North AmericaGastrointestinal bleeding
2023, Deutsche Medizinische Wochenschrift
- ☆
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.
- ☆☆
37/1/92896