Site and size of bleeding peptic ulcer. Is there any relation to the efficacy of hemostatic sclerotherapy?
In 78 patients with high-risk bleeding peptic ulcers (either with active bleeding or non-bleeding visible vessel) endoscopic hemostasis by injection of adrenaline and polidocanol was attempted. Sclerotherapy was performed in 70 (90%) patients. Initial hemostasis was achieved in 35 (94.5%) patients with active bleeding, and permanent hemostasis in 61 (87%). Efficacy of injection therapy was significantly lower in ulcers larger than 2 cm (p = 0.001), and in those located on the posteroinferior duodenal wall (p = 0.03). It was not possible to perform endoscopic injection in 8 (10%) patients due to difficulty of access, lesions located mainly high on the lesser gastric curvature and on the posteroinferior duodenal wall. From these results we conclude that endoscopic injection is a very useful technique for the initial treatment of high-risk bleeding peptic ulcer, although the size and anatomical location of the lesions may be a limitation of its use.
Brullet
E
E
Endoscopy Unit, Hospital de Sabadell, Barcelona, Spain.
Campo
R
R
Bedos
G
G
Barcons
S
S
Gubern
J M
JM
Bordas
J M
JM
D000368:Aged; D004381:Duodenal Ulcer / Q000150:complications* / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy; D013270:Stomach / Q000473:pathology; D013276:Stomach Ulcer / Q000150:complications* / Q000473:pathology
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols; D004837:Epinephrine