title: Randomized trial of normal saline solution injection versus bipolar electrocoagulation for treatment of patients with high-risk bleeding ulcers: is local tamponade enough?
abstract: BACKGROUND
  Endoscopic injection of normal saline solution is reportedly an effective treatment for bleeding ulcers. If it is as effective as standard therapy, low cost, wide availability, and lack of injury would make saline solution injection an attractive option.
  
  
  METHODS
  Patients with clinical evidence of major bleeding from an ulcer with active bleeding or a nonbleeding visible vessel were randomly assigned to injection with normal saline solution (1-2 mL boluses; mean volume 30 mL) or bipolar electrocoagulation (20 W, 10-sec applications; mean time 100 sec). Patients, those caring for patients, and those collecting data were blinded to therapy.
  
  
  RESULTS
  Further bleeding occurred in 14 (29%) of 48 patients in the saline solution group versus 6 (12%) of 52 patients in the bipolar group (95% CI [2%, 33%]; p = 0.04). Significantly more units of blood were transfused in the saline solution group (median 2 units vs. 0 units; p = 0.01). Hospital days (median 4 vs. 3) and mortality (6% vs. 2%) were not significantly different in the 2 groups. Independent risk factors for further bleeding were saline solution injection (p = 0.02), units transfused before therapy (p = 0.02), and ulcer size (p = 0.03).
  
  
  CONCLUSIONS
  Local tamponade with saline solution injection is less effective than bipolar electrocoagulation for the treatment of bleeding ulcers.
authors.affiliation: Division of Gastrointestinal and Liver Diseases, USC School of Medicine, Los Angeles, California 90033, USA.
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
authors.forename: Roque
authors.initials: R
authors.lastname: Estrada
mesh_terms: D004311:Double-Blind Method; D004564:Electrocoagulation; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D012008:Recurrence; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage*
chemical_list: D012965:Sodium Chloride