A prospective randomized trial of heater probe thermocoagulation versus injection therapy in peptic ulcer hemorrhage.
BACKGROUND
A prospective, randomized study was performed to compare the hemostatic effect of injection therapy and heater probe thermocoagulation in the treatment of peptic ulcer bleeding.


METHODS
This study includes 104 patients with upper gastrointestinal bleeding in whom endoscopy revealed a gastric or duodenal ulcer with nonbleeding or bleeding vessel (n = 66), oozing hemorrhage (n = 21), or adherent red clot (n = 17). Patients with other stigmata or clean ulcers were excluded. Patients were randomly assigned during endoscopy to receive injection therapy (adrenaline and polidocanol) (n = 51) or heater probe thermocoagulation (10F probe, at setting of 30 J (n = 53). Therapy was considered successful if there was no further hemorrhage or only minor rebleeding that was controlled with a second endoscopic procedure. Patients with major rebleeding or failure of retreatment underwent emergency surgery.


RESULTS
There were no significant differences in effectiveness between injection therapy and thermocoagulation in any of the assessed parameters: the percentage of patients with major recurrent hemorrhage (4% vs 6%) or minor rebleeding (16% vs 17%), need for emergency surgery (two patients from each group), transfusion requirement (0.45 +/- 0.9 units vs 0.51 +/- 1.1 units), the mean number of hospitalization days (7.1 +/- 4.2 vs 6.9 +/- 4.9), and mortality (one patient from each group died).


CONCLUSIONS
Injection therapy and heater probe have similar efficacies in the treatment of bleeding peptic ulcers.
Llach
J
J
Department of Gastroenterology, Hospital Clinic i Provincial, Barcelona, Spain.
Bordas
J M
JM
Salmerón
J M
JM
Panés
J
J
García-Pagán
J C
JC
Feu
F
F
Navasa
M
M
Mondelo
F
F
Piqué
J M
JM
Mas
A
A
Terés
J
J
Rodés
J
J
D000322:Adrenergic Agonists / Q000008:administration & dosage; D004564:Electrocoagulation / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000628:therapy*; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000628:therapy*; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols; D004837:Epinephrine