title: Endoscopic hemostasis of a bleeding marginal ulcer: hemoclipping or dual therapy with epinephrine injection and heater probe thermocoagulation.
abstract: 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.
authors.affiliation: Department of Internal Medicine, En Chu Kong Hospital, Taipei, Taiwan.
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Lee
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.forename: Chang-Shiu
authors.initials: CS
authors.lastname: Yang
authors.forename: Tzeng-Huey
authors.initials: TH
authors.lastname: Yang
authors.forename: Jiann-Hwa
authors.initials: JH
authors.lastname: Chen
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Chiang-Yen
authors.initials: CY
authors.lastname: Tsai
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Chang
authors.forename: Shih-Pei
authors.initials: SP
authors.lastname: Huang
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
mesh_terms: 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
chemical_list: D000322:Adrenergic Agonists; D004837:Epinephrine