title: Comparison of hemostatic efficacy of argon plasma coagulation with and without distilled water injection in treating high-risk bleeding ulcers.
abstract: BACKGROUND
  Argon plasma coagulation (APC) is useful to treat upper gastrointestinal bleeding, but its hemostatic efficacy has received little attention. Aims. This investigation attempted to determine whether additional endoscopic injection before APC could improve hemostatic efficacy in treating high-risk bleeding ulcers.
  
  
  METHODS
  From January 2007 to April 2011, adult patients with high-risk bleeding ulcers were included. This investigation compared APC plus distilled water injection (combined group) to APC alone for treating high-risk bleeding ulcers. Outcomes were assessed based on initial hemostasis, surgery, blood transfusion, hospital stay, rebleeding, and mortality at 30 days posttreatment.
  
  
  RESULTS
  Totally 120 selected patients were analyzed. Initial hemostasis was accomplished in 59 patients treated with combined therapy and 57 patients treated with APC alone. No significant differences were noted between these groups in recurred bleeding, emergency surgery, 30-day mortality, hospital stay, or transfusion requirements. Comparing the combined end point of mortality plus the failure of initial hemostasis, rebleeding, and the need for surgery revealed an advantage for the combined group (P = 0.040).
  
  
  CONCLUSIONS
  Endoscopic therapy with APC plus distilled water injection was no more effective than APC alone in treating high-risk bleeding ulcers, whereas combined therapy was potentially superior for patients with poor overall outcomes.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 81362, Taiwan.
authors.forename: Yuan-Rung
authors.identifier: 0000-0002-5041-7731
authors.initials: YR
authors.lastname: Li
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 81362, Taiwan.
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 81362, Taiwan.
authors.forename: Huay-Min
authors.identifier: 0000-0002-3221-2820
authors.initials: HM
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 81362, Taiwan ; Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan.
authors.forename: Hoi-Hung
authors.initials: HH
authors.lastname: Chan
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 81362, Taiwan.
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 81362, Taiwan.
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Tsai
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 81362, Taiwan.
authors.forename: Hsien-Chung
authors.initials: HC
authors.lastname: Yu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 81362, Taiwan.
authors.forename: Feng-Woei
authors.initials: FW
authors.lastname: Tsay
mesh_terms: D000328:Adult; D000368:Aged; D057908:Argon Plasma Coagulation; D005260:Female; D006470:Hemorrhage / Q000150:complications* / Q000628:therapy*; D006490:Hemostatics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications* / Q000628:therapy*; D014867:Water / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D006490:Hemostatics; D014867:Water