title: Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan.
authors.forename: Ching-Chu
authors.initials: CC
authors.lastname: Lo
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.forename: Gin-Ho
authors.initials: GH
authors.lastname: Lo
authors.forename: Chiun-Ku
authors.initials: CK
authors.lastname: Lin
authors.forename: Hoi-Hung
authors.initials: HH
authors.lastname: Chan
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Tsai
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chen
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Hsien-Chung
authors.initials: HC
authors.lastname: Yu
authors.forename: Jin-Shiung
authors.initials: JS
authors.lastname: Cheng
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Lai
mesh_terms: 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*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine