title: Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots.
abstract: OBJECTIVE
  Treatment of high-risk patients with nonbleeding adherent clots on ulcers is controversial. In a previous randomized trial, there was no benefit to endoscopic therapies compared with medical therapy for prevention of ulcer rebleeding. Our purpose was to test the hypothesis that patients treated with combination endoscopic therapy would have significantly lower rebleeding rates than those treated with medical therapy.
  
  
  METHODS
  In this randomized, controlled trial, 32 high-risk patients with severe ulcer hemorrhage and nonbleeding adherent clots resistant to target irrigation were randomized to medical therapy or to combination endoscopic therapy (with epinephrine injection, shaving down the clot with cold guillotining, and bipolar coagulation on the underlying stigmata). Physicians blinded to the endoscopic therapy managed all patients.
  
  
  RESULTS
  Patients were similar at study entry, except for older age in the medical group and lower platelet count in the endoscopic group. By hospital discharge, significantly more medically treated patients (6/17; 35.3%) than endoscopically treated patients (0/15; 0%) rebled (P = 0.011). There were no complications of endoscopic treatment.
  
  
  CONCLUSIONS
  Combination endoscopic therapy of nonbleeding adherent clots significantly reduced early ulcer rebleeding rates in high-risk patients compared with medical therapy alone. This endoscopic treatment was safe.
authors.affiliation: CURE Digestive Disease Research Center, UCLA School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA. djensen@mednet.ucla.edu
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Jensen
authors.forename: Thomas O G
authors.initials: TO
authors.lastname: Kovacs
authors.forename: Rome
authors.initials: R
authors.lastname: Jutabha
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Machicado
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gralnek
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Savides
authors.forename: James
authors.initials: J
authors.lastname: Smith
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Jensen
authors.forename: Gwen
authors.initials: G
authors.lastname: Alofaituli
authors.forename: Jeff
authors.initials: J
authors.lastname: Gornbein
mesh_terms: D000368:Aged; D001777:Blood Coagulation; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000628:therapy*; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D012008:Recurrence