Endoscopic hemostasis of a bleeding marginal ulcer: hemoclipping or dual therapy with epinephrine injection and heater probe thermocoagulation.
OBJECTIVE
Endoscopic hemoclipping and dual therapy with epinephrine injection and heater probe thermocoagulation have been proven effective in the hemostasis of bleeding peptic ulcers. However, the hemostatic efficacy has not been investigated in bleeding marginal ulcers. The aim of this study is to investigate the hemostatic efficacy of endoscopic hemoclipping and dual therapy with epinephrine injection and heater probe thermocoagulation in bleeding marginal ulcers.


METHODS
From November 1997 to July 2000, 50 patients with active marginal ulcer bleeding underwent either hemoclipping (20 patients) or dual therapy (30 patients) for hemostasis. The demographic data, clinicopathological characteristics, endoscopic findings, initial hemostatic rates, rebleeding rates, amount of blood transfusion, the need of surgery, and mortality rates were collected and analyzed.


RESULTS
Marginal ulcers were located at the anastomotic site (64%), saddle portion (22%), efferent loop (10%), or at the afferent loop (4%). The bleeding stigmata were classified into spurting artery (32%), oozing vessel (38%), visible vessel (20%), and blood clot adhesion (10%). The overall therapeutic results in 50 patients were initial hemostasis (100%), rebleeding rate (22%), need for surgery (4%), and hospital mortality rate (4%). There was no significant difference in demographic data and clinicopathological characteristics between the two modes of treatments, whereas recurrent bleeding developed in 5% in the hemoclipping group and 33% in the dual therapy group. No complication related to the procedure occurred in either mode of therapy. The hospital mortality rates were 0 and 6.7%, respectively.


CONCLUSIONS
Endoscopy is effective in achieving initial hemostasis from bleeding marginal ulcers. However, the rebleeding rate remains high and repeated endoscopy may be needed to arrest the hemorrhage.
Lee
Yi-Chia
YC
Department of Internal Medicine, En Chu Kong Hospital, Taipei, Taiwan.
Wang
Hsiu-Po
HP
Yang
Chang-Shiu
CS
Yang
Tzeng-Huey
TH
Chen
Jiann-Hwa
JH
Lin
Chun-Che
CC
Tsai
Chiang-Yen
CY
Chang
Li-Ying
LY
Huang
Shih-Pei
SP
Wu
Ming-Shiang
MS
Lin
Jaw-Town
JT
D000322:Adrenergic Agonists / Q000008:administration & dosage*; D000368:Aged; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D004564:Electrocoagulation / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005773:Gastroscopy; D016558:Hemostasis, Endoscopic / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D004837:Epinephrine