title: A Randomized Trial of Monopolar Soft-mode Coagulation Versus Heater Probe Thermocoagulation for Peptic Ulcer Bleeding.
abstract: OBJECTIVE
  Endoscopic therapy has been demonstrated to be effective in achieving hemostasis for bleeding peptic ulcers. Thermal coagulation is one of the most commonly used methods, with a high success rate. Recently, endoscopic submucosal dissection for early gastric carcinoma was developed and hemostasis with soft coagulation using hemostatic forceps was introduced. The aim of this study was to compare the hemostatic efficacy of soft coagulation with heater probe thermocoagulation for peptic ulcer bleeding.
  
  
  METHODS
  Patients who visited our hospital with hematemesis or melena underwent emergency endoscopy. Inclusion criteria were presentation with an actively bleeding ulcer, a nonbleeding visible vessel, or an adherent clot. Patients were excluded if they were unwilling to give written informed consent or had a bleeding gastric malignancy. Patients were randomized to receive endoscopic hemostasis with soft coagulation (Group S) or heater probe thermocoagulation (Group H). The primary endpoint was the primary hemostasis rate and secondary endpoints were rebleeding rate, complications, and the procedure time.
  
  
  RESULTS
  Between May 2010 and February 2012, a total of 111 patients (89 gastric ulcers and 22 duodenal ulcers) were enrolled. Primary hemostasis was achieved in 54 patients (96%) in Group S and 37 (67%) in Group H (P<0.0001). Rebleeding occurred in 7 patients in Group H and none in Group S. Of these 7 patients, urgent surgery was performed in 1. Perforation occurred in 2 patients in Group H, which was managed conservatively.
  
  
  CONCLUSIONS
  For patients with gastroduodenal ulcer bleeding, soft coagulation using monopolar hemostatic forceps is more effective than heater probe thermocoagulation for achieving hemostasis.
authors.affiliation: *Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama †Division of Endoscopy, Okayama University Hospital, Okayama, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Nunoue
authors.forename: Ryuta
authors.initials: R
authors.lastname: Takenaka
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hori
authors.forename: Noriko
authors.initials: N
authors.lastname: Okazaki
authors.forename: Kenta
authors.initials: K
authors.lastname: Hamada
authors.forename: Yuki
authors.initials: Y
authors.lastname: Baba
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yamasaki
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Kono
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Seki
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Inokuchi
authors.forename: Koji
authors.initials: K
authors.lastname: Takemoto
authors.forename: Akihiko
authors.initials: A
authors.lastname: Taira
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tsugeno
authors.forename: Shigeatsu
authors.initials: S
authors.lastname: Fujiki
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kawahara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004381:Duodenal Ulcer / Q000601:surgery*; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery*; D011446:Prospective Studies; D013276:Stomach Ulcer / Q000601:surgery*; D016896:Treatment Outcome