Endoscopic haemoclip versus heater probe thermocoagulation plus hypertonic saline-epinephrine injection for peptic ulcer bleeding.
BACKGROUND
Treating patients of bleeding peptic ulcers with heater probe thermocoagulation and haemoclip is considered to be safe and very effective. Yet, there is no report comparing the haemostatic effects of endoscopic haemoclip versus heater probe thermocoagulation plus hypertonic saline-epinephrine injection in these patients.


OBJECTIVE
To compare the clinical outcomes of both therapeutic modalities in patients with peptic ulcer bleeding.


METHODS
A total of 93 patients with active bleeding or non-bleeding visible vessels were randomised to receive either endoscopic haemoclip (n = 46) or heater probe thermocoagulation plus hypertonic saline-epinephrine injection (n = 47). Five patients from the haemoclip group were excluded because of the inability to place the haemoclip.


RESULTS
Initial haemostasis was achieved in 39 patients (95.1%) of the haemoclip group and 47 patients (100%) of the heater probe group (P > 0.1). Rebleeding occurred in four patients (10.3%) of the haemoclip group and three patients (6.4%) of the heater probe group (P > 0.1). The volume of blood transfused after entry into the study, duration of hospital stay, number of patients requiring urgent surgery and the mortality rates were not statistically different between the two groups.


CONCLUSIONS
If the haemoclip can be applied properly, the clinical outcomes of the haemoclip group would be similar to those of the heater probe group in patients with peptic ulcer bleeding. However, if the bleeders are located at the difficult-to-approach sites, heater probe plus hypertonic saline injection is the first choice therapy.
Lin
H J
HJ
Division of Gastroenterology, Department of Medicine, VGH-TAIPEI, Shih-Pai Road, Sec 2, Taipei 11217, Taiwan, ROC. hjlin@vghtpe.gov.tw
Perng
C L
CL
Sun
I C
IC
Tseng
G Y
GY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D004564:Electrocoagulation / Q000295:instrumentation*; D016145:Endoscopy, Digestive System / Q000295:instrumentation*; D004837:Epinephrine / Q000627:therapeutic use*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012008:Recurrence; D012462:Saline Solution, Hypertonic; D016037:Single-Blind Method; D013525:Surgical Instruments; D016019:Survival Analysis; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D012462:Saline Solution, Hypertonic; D014662:Vasoconstrictor Agents; D004837:Epinephrine