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Recurrent bleeding from peptic ulcer associated with adherent clot: a randomized study comparing endoscopic treatment
Brian L Bleau1, Christopher J Gostout, Kenneth E Sherman
1Tacoma Digestive Diseases, Tacoma, Washington, USA.
Insights
Endoscopic therapy, including clot removal, significantly reduces recurrent gastrointestinal bleeding in patients with peptic ulcers and adherent clots compared to medical management alone. This approach offers a more effective treatment for this specific patient group.
Area of Science:
- Gastroenterology
- Endoscopy
- Gastrointestinal Bleeding
Background:
- Endoscopic therapy is established for actively bleeding peptic ulcers.
- Its efficacy for ulcers with adherent clots is debated.
- This study addresses the controversy surrounding endoscopic intervention for such cases.
Purpose of the Study:
- To evaluate if clot removal and endoscopic therapy decrease recurrent bleeding in peptic ulcers with adherent clots.
- To compare endoscopic management versus medical management for this condition.
Main Methods:
- Multicenter randomized trial of patients with GI bleeding from peptic ulcers with adherent clots.
- Interventions included endoscopic therapy (epinephrine injection, mechanical clot removal, coagulation) or medical management.
- Patients received standard ulcer treatment; outcomes assessed over 1 month.
Main Results:
- Recurrent bleeding occurred in 34.3% of patients receiving medical therapy (12/35).
- Recurrent bleeding occurred in only 4.8% of patients receiving endoscopic therapy (1/21).
- The difference in recurrent bleeding rates was statistically significant (p < 0.02).
Conclusions:
- Endoscopic therapy, involving clot removal and coagulation, is significantly more effective than medical therapy alone.
- This approach reduces recurrent bleeding in patients with gastric or duodenal ulcers presenting with adherent clots.
- The findings support the use of endoscopic intervention for peptic ulcers with adherent clots.
Background:
Endoscopic therapy reduces the recurrence of bleeding from actively bleeding peptic ulcers and those with visible vessels. However, the use of endoscopic therapy for ulcers with adherent clots remains controversial. The purpose of this study was to determine whether removal of clot from an ulcer and endoscopic therapy reduces the frequency of recurrent bleeding.
Methods:
Patients with acute upper GI bleeding from peptic ulcers with adherent clots and no active bleeding were enrolled in a multicenter study. At each center patients were stratified for age, use of nonsteroidal anti-inflammatory drugs, and ulcer location, and were randomized to endoscopic or medical management. Endoscopic therapy consisted of injection of the base of the adherent clot with a solution of epinephrine and mechanical removal of the clot. The base of the ulcer and any stigmata of bleeding were then coagulated until cavitation and adequate coagulation were obtained. Patients in both groups received standard medical therapy for peptic ulcer. Patients were evaluated for recurrence of bleeding for 1 month.
Results:
Fifty-six patients were enrolled. Rates of recurrent bleeding were 34.3% (12/35) in the medical treatment arm versus 4.8% (1/21) in the endoscopic treatment arm (p < 0.02).
Conclusions:
In patients with GI bleeding caused by gastric or duodenal ulcers with an adherent clot found on endoscopy, endoscopic therapy with injection of the base of the clot, clot removal, and heat probe coagulation significantly reduces the rate of recurrent bleeding compared with medical therapy alone.