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Injection therapy for endoscopic haemostasis.

N I Church1, K R Palmer

  • 1Gastrointestinal Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.

Bailliere'S Best Practice & Research. Clinical Gastroenterology
|August 23, 2000
PubMed
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Endoscopic injection effectively stops active ulcer bleeding and prevents re-bleeding. Fibrin glue and thrombin injections show the best results for stable clot formation, offering a valuable treatment for gastrointestinal bleeding.

Area of Science:

  • Gastroenterology
  • Endoscopic Hemostasis

Background:

  • Endoscopic injection is a common treatment for active ulcer bleeding and preventing re-bleeding from ulcers with visible vessels.
  • The precise mechanisms of action for endoscopic injection therapies remain unclear, with proposed theories including tamponade, vasoconstriction, and direct effects on clotting.

Purpose of the Study:

  • To review the efficacy and mechanisms of endoscopic injection therapies for managing peptic ulcer bleeding.
  • To compare different endoscopic hemostatic agents and modalities.

Main Methods:

  • Review of clinical trials on endoscopic injection therapies for ulcer bleeding.
  • Evaluation of agents like adrenaline, sclerosants, alcohol, fibrin glue, and thrombin.
  • Comparison with thermal modalities such as heater probe and BICAP electrocoagulation.

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Main Results:

  • Dilute adrenaline is effective, but adding sclerosants or alcohol provides no extra benefit and increases side-effects.
  • Fibrin glue and thrombin injections yield the best results by promoting stable clot formation.
  • Endoscopic injection and thermal modalities demonstrate comparable efficacy; combination therapy may benefit severe bleeding cases.

Conclusions:

  • Fibrin glue and thrombin are superior endoscopic injection agents for achieving hemostasis in ulcer bleeding.
  • Combining injection with thermal modalities can enhance treatment outcomes, particularly in severe bleeding.
  • Further endoscopic intervention or surgery is considered for patients with re-bleeding based on clinical judgment.