Evaluation of endoscopic hemostasis with metallic hemoclips for bleeding gastric ulcer: comparison with endoscopic injection of absolute ethanol in a prospective, randomized study.
OBJECTIVE
Although metallic hemoclips have been used for hemostasis of bleeding ulcer, there have been few prospective trials to evaluate their efficacy. In this study, a prospective, randomized trial was performed to evaluate endoscopic hemoclipping for bleeding gastric ulcer in comparison with endoscopic injection of absolute ethanol.


METHODS
During the period 1995-1998, 126 gastric ulcer patients with bleeding or nonbleeding visible vessel were considered for entry. They were randomly assigned to one of three groups: endoscopic hemostasis performed with injection of absolute ethanol (group I, n = 42), hemoclipping (group II, n = 42), and a combination of the two methods (group III, n = 42).


RESULTS
The permanent hemostatic rate was 85.7% in group I, 90.5% in group II, and 92.9% in group III. The mean volume of blood transfusion was 313 +/- 77 ml in group I, 274 +/- 54 ml in group II, and 163 +/- 42 ml in group III, which was significantly less than in groups I or II (p < 0.05). No patients required emergency surgery. Five patients died within a month after initial hemostasis as a result of unrelated conditions.


CONCLUSIONS
Endoscopic hemostasis with hemoclips for bleeding gastric ulcer was as effective and safe as that with injection of absolute ethanol, and a combination of ethanol injection and hemoclips did not result in a great advantage over the two individual procedures.
Department of Internal Medicine, Saga Medical School, Nabeshima, Saga, Japan.
Ryo
R
Shimoda
Ryuichi
R
Iwakiri
Hiroyuki
H
Sakata
Shinichi
S
Ogata
Atsushi
A
Kikkawa
Hibiki
H
Ootani
Kayoko
K
Oda
Akifumi
A
Ootani
Seiji
S
Tsunada
Kazuma
K
Fujimoto
D004867:Equipment Design; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008670:Metals; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D012016:Reference Values; D012597:Sclerosing Solutions / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013276:Stomach Ulcer / Q000175:diagnosis / Q000628:therapy*; D013525:Surgical Instruments; D016896:Treatment Outcome
D008670:Metals; D012597:Sclerosing Solutions; D000431:Ethanol