Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers.
BACKGROUND
Rebleeding occurs in 10% to 30% of bleeding ulcer patients receiving endoscopic epinephrine injection therapy. It remains unclear whether addition of a secondary clip therapy following epinephrine injection may reduce the rebleeding rate of high-risk bleeding ulcers.


OBJECTIVE
To compare the efficacies of epinephrine injection alone and epinephrine injection combined with hemoclip therapy in treating high-risk bleeding ulcers.


METHODS
Prospective randomized controlled trial.


METHODS
A medical center in Taiwan.


METHODS
One hundred five bleeding ulcer patients with active spurting, oozing, nonbleeding visible vessels or adherent clots in ulcer bases.


METHODS
Endoscopic combination therapy (n = 52) or diluted epinephrine injection alone (n = 53).


METHODS
Initial hemostasis rates and recurrent bleeding rates.


RESULTS
Initial hemostasis was achieved in 51 patients treated with combination therapy and 49 patients with epinephrine injection therapy (98% vs 92%, P = .18). Bleeding recurred in 2 patients in the combination therapy group and 11 patients in the epinephrine injection group (3.8% vs 21%, P = .008). Among the patients with rebleeding, repeated combination therapy was more effective than repeated injection therapy in achieving permanent hemostasis (100% vs 33%, P = .02). No patient required an emergency operation in the combination therapy group. However, 5 patients in the epinephrine injection group underwent emergency surgery to arrest bleeding (0% vs 9%, P = .023).


CONCLUSIONS
Treatment outcome of endoscopic hemoclip therapy is related to the techniques of endoscopists.


CONCLUSIONS
Endoscopic combination therapy is superior to epinephrine injection alone in the treatment of high-risk bleeding ulcers.
Lo
Ching-Chu
CC
Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan.
Hsu
Ping-I
PI
Lo
Gin-Ho
GH
Lin
Chiun-Ku
CK
Chan
Hoi-Hung
HH
Tsai
Wei-Lun
WL
Chen
Wen-Chi
WC
Wu
Chung-Jen
CJ
Yu
Hsien-Chung
HC
Cheng
Jin-Shiung
JS
Lai
Kwok-Hung
KH
D000368:Aged; D003131:Combined Modality Therapy; D004381:Duodenal Ulcer / Q000601:surgery*; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007267:Injections; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D013276:Stomach Ulcer / Q000601:surgery*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D004837:Epinephrine