Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers.
BACKGROUND
The endoscopic hemoclip method is a safe and effective hemostatic method for managing bleeding peptic ulcers. We compared the hemostatic efficacy of the endoscopic hemoclip method with that of hypertonic saline-epinephrine (HSE) injection and a combined method in the management of bleeding peptic ulcers.


METHODS
From July 1994 to July 1997, we conducted a randomized clinical trial of endoscopic hemostasis involving 124 patients with actively bleeding or visible vessels at endoscopic inspection.


RESULTS
Patients were randomly assigned to hemoclip (41 patients), HSE (41 patients), and combined treatment groups (42 patients). Initial hemostasis was achieved in 97.6%, 95.1%, and 97.6% of cases, respectively. Recurrent bleeding developed in 2.4%, 14.6%, and 9.5% of cases. Emergency operations were performed in 4.9%, 14.6%, and 2.3% of cases. The hemostasis rate was 71.4%, 50%, and 66.7% for spurting hemorrhage in each group. Permanent hemostasis was achieved in 95.1%, 85.4%, and 95.2% of cases. Three patients had complications, all in the HSE group.


CONCLUSIONS
The hemoclip method is an effective hemostatic procedure and is safer than HSE injection. The combined method does not provide substantial advantage over use of the hemoclip method alone in the hemostatic management of bleeding peptic ulcers.
Chung
I K
IK
Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Choongnam, Republic of Korea.
Ham
J S
JS
Kim
H S
HS
Park
S H
SH
Lee
M H
MH
Kim
S J
SJ
D004338:Drug Combinations; D004381:Duodenal Ulcer / Q000150:complications / Q000473:pathology; D016145:Endoscopy, Digestive System; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012449:Safety; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage* / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000150:complications / Q000473:pathology; D013525:Surgical Instruments; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use
D004338:Drug Combinations; D012462:Saline Solution, Hypertonic; D014662:Vasoconstrictor Agents; D004837:Epinephrine