Monopolar coagulation versus conventional endoscopic treatment for high-risk peptic ulcer bleeding: a prospective, randomized study

Severe upper GI hemorrhage from an actively bleeding peptic ulcer is sometimes difficult to treat by conventional endoscopic means, such as multipolar electrocoagulation, heat probe coagulation, and injection therapy. It was hypothesized that monopolar coagulation with a "hot biopsy" forceps may be more effective in such cases.

A prospective, randomized trial was performed to assess the safety and short-term efficacy of monopolar coagulation versus conventional treatment (combination heat probe coagulation and injection therapy) in the treatment of patients with various types of actively bleeding or high-risk ulcers.

Primary hemostasis was achieved in 54 of 56 actively bleeding patients in the monopolar coagulation group. In contrast, primary hemostasis was achieved in 33 of 43 patients in the control group (p = 0.003), with 8 of the remaining 10 being treated successfully by crossover monopolar coagulation. During 30-day follow-up, bleeding recurred in 6 patients in the conventional therapy group versus none in the monopolar coagulation group (p = 0.012). Post-endoscopy blood transfusion requirements were lower in the monopolar coagulation group. Mortality and surgery rates were zero in both groups. There was no procedure-related complication.

This study demonstrated improved primary hemostasis and a reduced short-term rate of recurrent bleeding for patients with actively bleeding and high-risk non-bleeding peptic ulcers treated by monopolar coagulation. The complication rate associated with monopolar coagulation was low.