A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers.
BACKGROUND
A randomized comparative study was conducted of injection therapy with epinephrine-polidocanol (1%) versus hemoclip application, versus injection combined with hemoclip for bleeding peptic ulcers.


METHODS
One hundred five patients were randomized and 101 could be evaluated (46 had active spurting or oozing of blood; 55 a visible vessel). Patients were randomized to 1 of the 3 treatment modalities during endoscopy performed within 12 hours of admission. Endoscopy was repeated after 1 day or at recurrence of bleeding and before discharge. In case of recurrent bleeding, patients were retreated with the same modality.


RESULTS
Initial failure or the rate of early recurrence of bleeding was highest (but not statistically significant) in the hemoclip group (13/35; 37%), versus the injection (5/34; 15%) and combination (8/32; 25%) groups. Overall failure was significantly (p = 0.01) different among the 3 groups with the highest rate in the hemoclip group (12/35; 34%), versus the injection (2/34; 6%) and combination therapy (8/32; 25%) groups. The use of hemoclips alone appeared to fail because of difficulty with hemoclip placement and incomplete vessel compression. Complications included 1 perforation in the injection group and possibly 1 case of septic arthritis in the combination therapy group.


CONCLUSIONS
In this study, endoscopic treatment of bleeding peptic ulcers with the hemoclip was inferior overall to injection therapy.
Gevers
Anna-Maria
AM
Department of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
De Goede
Eric
E
Simoens
Marc
M
Hiele
Martin
M
Rutgeerts
Paul
P
D000368:Aged; D003131:Combined Modality Therapy; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005773:Gastroscopy; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007267:Injections; D008026:Ligation / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D012597:Sclerosing Solutions; D014662:Vasoconstrictor Agents; D000077423:Polidocanol; D011092:Polyethylene Glycols; D004837:Epinephrine