Endoscopic hemostasis of gastric ulcer bleeding by hemostatic forceps coagulation

Endoscopic submucosal dissection (ESD) for early gastric carcinoma has been widely performed in Japan. In this technique, when hemorrhaging from vessels is observed, the bleeding point is coagulated using hemostatic forceps with the soft coagulation. There have been reports that using hemostatic forceps with soft coagulation is a safe and effective method of controlling upper gastrointestinal ulcer bleeding. However, there have been no reports regarding the comparative effectiveness of hemostatic forceps and clipping in upper gastrointestinal ulcer bleeding. Between April 2003 and December 2008, a total of 124 patients with gastric ulcer bleeding causing melena or hematochezia were treated with endoscopic hemostasis in our hospital. Two endoscopic hemostatic methods were used for different groups of patients: coagulation with hemostatic forceps was used for Group A and clipping was used for Group B. The rate of additional treatment required after the initial procedure was 28.6% (8/28) for Group A and 79.2% (76/96) for Group B, indicating a significantly lower rate for Group A than that for Group B (P < 0.01). Additional treatment consists of a hypertonic saline epinephrine injection. The rebleeding rate was 3.6% (1/28) for Group A and 8.3% (8/96) for Group B, again indicating a lower rate for Group A than for Group B. Finally, successful endoscopic hemostasis was 100% in both groups. Using the soft coagulation mode of hemostatic forceps is shown to be a safe, easy and effective method of controlling gastric ulcer bleeding in relation to clipping.