A randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels.
OBJECTIVE
A randomised controlled comparison of haemostatic efficacy of mechanical, injection, and thermal methods of haemostasis was undertaken using canine mesenteric vessels to test the hypothesis that mechanical methods of haemostasis are more effective in controlling haemorrhage than injection or thermal methods. The diameter of arteries in human bleeding ulcers measures up to 3.45 mm; mesenteric vessels up to 5 mm were therefore studied.


METHODS
Mesenteric vessels were randomised to treatment with injection sclerotherapy (adrenaline and ethanolamine), bipolar diathermy, or mechanical methods (band, clips, sewing machine, endoloops). The vessels were severed and haemostasis recorded.


RESULTS
Injection sclerotherapy and clips failed to stop bleeding from vessels of 1 mm (n = 20) and 2 mm (n = 20). Bipolar diathermy was effective on 8/10 vessels of 2 mm but failed on 3 mm vessels (n = 5). Unstretched elastic bands succeeded on 13/15 vessels of 2 mm but on only 3/10 vessels of 3 mm. The sewing machine achieved haemostasis on 8/10 vessels of 4 mm but failed on 5 mm vessels (n = 5); endoloops were effective on all 5 mm vessels (n = 5).


CONCLUSIONS
Only mechanical methods were effective on vessels greater than 2 mm in diameter. Some mechanical methods (banding and clips) were less effective than expected and need modification. Thermal and (effective) mechanical methods were significantly (p < 0.01) more effective than injection sclerotherapy. The most effective mechanical methods were significantly more effective (p < 0.01) than thermal or injection on vessels greater than 2 mm.
Hepworth
C C
CC
GI Science Research Unit, St Bartholomew's, School of Medicine and Dentistry, London, UK.
Kadirkamanathan
S S
SS
Gong
F
F
Swain
C P
CP
D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004564:Electrocoagulation; D005069:Evaluation Studies as Topic; D016558:Hemostasis, Endoscopic; D006488:Hemostasis, Surgical; D006489:Hemostatic Techniques; D008638:Mesenteric Arteries; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery / Q000628:therapy; D011897:Random Allocation; D015911:Sclerotherapy