Adrenaline injection plus argon plasma coagulation versus adrenaline injection plus hemoclips for treating high-risk bleeding peptic ulcers: a prospective, randomized trial.
OBJECTIVE
Several combination endoscopic therapies are currently in use. The present study aimed to compare argon plasma coagulation (APC) + adrenaline injection (AI) with hemoclips + AI for the treatment of high-risk bleeding peptic ulcers.


METHODS
In a prospective randomized trial, 172 patients with major stigmata of peptic ulcer bleeding were randomly assigned to receive APC + AI (n = 89) or hemoclips + AI (n = 83). In the event of rebleeding, the initial modality was used again. Patients in whom treatment or retreatment was unsuccessful underwent emergency surgery. The primary end point of rebleeding rate and secondary end points of initial and definitive hemostasis need for surgery and mortality were compared between the two groups.


RESULTS
The two groups were similar in all background variables. Definitive hemostasis was achieved in 85 of 89 (95.5%) of the APC + AI and 82 of 83 (98.8%) of the hemoclips + AI group (P = 0.206). The mean volume of adrenaline injected in the two groups was equal (20.7 mL; P = 0.996). There was no significant difference in terms of initial hemostasis (96.6% versus 98.8%; P = 0.337), rate of rebleeding (11.2% versus 4.8%; P = 0.124), need for surgery (4.5% versus 1.2%; P = 0.266) and mortality (2.2% versus 1.2%; P = 0.526). When compared for the combined end point of mortality plus rebleeding and the need for surgery, there was an advantage for the hemoclip group (6% versus 15.7%, P = 0.042).


CONCLUSIONS
Hemoclips + AI has no superiority over APC + AI in treating patients with high-risk bleeding peptic ulcers. Hemoclips + AI may be superior when a combination of all negative outcomes is considered.
Taghavi
Seyed Alireza
SA
Gastroenterohepatology Research Centre, Nemazee Hospital, Shiraz, Iran. ataghavi@sums.ac.ir
Soleimani
Seyed Mohammad
SM
Hosseini-Asl
Seyed Mohammad Kazem
SM
Eshraghian
Ahad
A
Eghbali
Hajar
H
Dehghani
Seyed Mohsen
SM
Ahmadpour
Bita
B
Saberifiroozi
Mehdi
M
D000328:Adult; D000368:Aged; D004564:Electrocoagulation / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D016558:Hemostasis, Endoscopic / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D014662:Vasoconstrictor Agents; D004837:Epinephrine