[Injection therapy of bleeding peptic ulcer with fibrin or polidocanol]

The effectiveness of injecting fibrin (group 1; with adrenalin: n = 11; without adrenalin: n = 29) or polidocanol (with [n = 17] or without adrenalin [n = 8]) or adrenalin alone (n = 15) (group 2) in the arrest of bleeding from peptic ulcers was compared in a prospective randomized study of 80 patients (61 males, 19 females; mean age 66.7 [28-92] years). Both groups were comparable regarding age, sex distribution, ulcer site and haemoglobin concentration. The amount of fibrin injected per patient at the first session averaged 2.9 +/- 1.8 ml, that of polidocanol 3.1 +/- 1.9 ml. The initial injection was successful in all but one patients (40 and 39, respectively). Primary definitive haemostasis was achieved in 59 patients (73.8%), with recurrence of bleeding in 20 (9 and 11: 25%). Recurrent bleeding was always treated with fibrin injection. Definitive haemostasis was achieved by a second application of fibrin in eight patients (10%), so that the definitive haemostasis rate was 83.8%. A second recurrence of bleeding was noted in eight patients, requiring surgical treatment. Four patients died during the second recurrence. It is concluded that injection of fibrin is an effective method of treatment of bleeding ulcer. There was no evidence that fibrin was better than polidocanol with or without adrenaline.