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Multipolar electrocoagulation in the treatment of peptic ulcers with nonbleeding visible vessels. A prospective,
1University of Southern California School of Medicine, Los Angeles.
Study Objective:
To assess the efficacy and safety of treatment with endoscopic multipolar electrocoagulation in patients who have ulcers with nonbleeding visible vessels.
Design:
Prospective, randomized, sham-controlled trial; patients were followed until their discharge from the hospital.
Setting:
Urban, nonreferral county hospital.
Patients:
Consecutive sample of 75 patients who had a bloody nasogastric aspirate sample, melena, or hematochezia; unstable vital signs, a transfusion of at least two units of blood in 12 hours, or a drop in the hematocrit of at least 0.06 in 12 hours; and endoscopic evidence of an ulcer with a nonbleeding visible vessel.
Intervention:
Sham or real multipolar electrocoagulation at the time of diagnostic endoscopy.
Measurements And Main Results:
Compared with the control group, the group receiving multipolar electrocoagulation showed marked improvement in the following variables; rebleeding (18% compared with 41%, P less than 0.05; difference, 23%; 95% CI, 3% to 43%); need for emergency surgery (8% compared with 30%, P less than 0.05; difference, 22%; CI, 5% to 39%); mean number of hospital days (4.3 +/- 0.4 compared with 6.2 +/- 0.7, P less than 0.05; difference, 1.9; CI, 0.4 to 3.4); and cost of hospitalization ($3790 +/- $410 compared with $5730 +/- $650, P less than 0.05; difference, $1940; CI, $400 to $3480). The mean transfusion requirement in the treatment group was 1.6 +/- 0.3 as compared with 3.0 +/- 0.6 units in the control group (P = 0.13; difference, 1.4; CI, 0 to 2.8). The overall mortality was extremely low: Only 1 (1%) of 75 patients died. Bleeding was induced in 7 (18%) of the 38 patients treated with electrocoagulation, and 1 patient required urgent surgery.
Conclusions:
Endoscopic treatment with multipolar electrocoagulation is beneficial in patients who present with major upper gastrointestinal hemorrhage and are found to have an ulcer with a nonbleeding visible vessel.
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