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Peptic ulcer bleeding: comparison of two hemostatic procedures
F Buffoli1, M Graffeo, F Nicosia
1Servizio di Endoscopia Digestiva, UF di Medicina Generale, Casa di Cura Poliambulanza, Brescia, Italy.
The American Journal of Gastroenterology
|February 24, 2001
Summary
Endoscopic injection therapy for bleeding peptic ulcers showed similar effectiveness between epinephrine injection alone and combined with Hemoclips. Combination therapy may be more effective for actively oozing ulcers, reducing rebleeding risk.
Area of Science:
- Gastroenterology
- Endoscopic interventions
- Gastrointestinal bleeding
Background:
- Peptic ulcer bleeding is a significant complication.
- Endoscopic injection therapy is a standard treatment for acute nonvariceal upper GI hemorrhages.
- Forrest's criteria predict rebleeding risk in bleeding peptic ulcers.
Purpose of the Study:
- To compare the efficacy of endoscopic epinephrine injection alone versus combined with Hemoclips for bleeding peptic ulcers.
- To evaluate rebleeding rates, need for surgery, and mortality in patients with bleeding peptic ulcers.
Main Methods:
- A study of 223 emergency upper endoscopies identified 99 patients with Forrest F1/F2 ulcers at risk of rebleeding.
- Group A received epinephrine injection; Group B received epinephrine injection plus Hemoclips.
- Outcomes measured included bleeding control, rebleeding episodes, emergency surgery, and mortality.
Main Results:
- Complete bleeding cessation was achieved in 83.3% of Group A and 95.6% of Group B (p=NS).
- Rebleeding rates for actively oozing ulcers (F1b) were 31% for Group A vs. 0% for Group B (p<0.05).
- No mortality occurred; a trend towards reduced surgery favored combined therapy.
Conclusions:
- Endoscopic epinephrine injection and combined epinephrine/Hemoclip therapy are equivalent for treating bleeding peptic ulcers.
- Both methods showed no significant difference in need for surgery or mortality.
- Combination therapy may offer superior efficacy for actively oozing ulcers.