Efficacy of endoscopic clipping for actively bleeding peptic ulcer: comparison with polidocanol injection therapy.
OBJECTIVE
The use of hemostatic clips is conceptually attractive for achieving definitive hemostasis in peptic ulcer bleeding. There are only a few clinical trials comparing clipping with other endoscopic hemostatic methods. The aim of this study is to assess the efficacy and safety of endoscopic clipping with that of injection of polidocanol for hemostasis from actively (spurting or oozing) bleeding peptic ulcer.


METHODS
61 patients with active (spurting or oozing) bleeding gastroduodenal ulcers were randomly assigned to one of two endoscopic treatments: injection therapy with polidocanol 1% (injected in 0.5-1.0 mL increments at three to five sites around the bleeding vessel to a total of 5 mL) (n=30), or endoscopic clipping using a clipping device and clips (n=31). All patients from the polidocanol group and 22 (68.8%) patients from the clipping group received pretreatment with epinephrine. Hemostatic rates, rebleeding rates, amounts of blood transfusion, and durations of hospital stay were analyzed.


RESULTS
The initial hemostatic rate was 96.8% in the clipping group, and 96.7% in the polidocanol group, respectively. Mean transfusion requirements, mean number of hospital days and percentage needing surgery were comparable in both groups. Recurrent bleeding rates were higher, although not statistically significant in the polidocanol group than in the clipping group (13.3% vs. 6.5%, respectively).


CONCLUSIONS
Our data suggest that injection therapy with polidocanol and endoscopic hemoclips seems to be equivalent for actively (spurting and oozing) bleeding peptic ulcer.
LJubicic
Neven
N
Division of Digestive Diseases, Endoscopy Unit, Department of Internal Medicine, Sestre milosrdnice Clinical Hospital, Zagreb, Croatia. neven.ljubicic@zg.tel.hr
Supanc
Vladimir
V
Vrsalovic
Mislav
M
D000328:Adult; D000368:Aged; D005260:Female; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D016896:Treatment Outcome
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols