Comparison of hemostatic forceps with soft coagulation versus argon plasma coagulation for bleeding peptic ulcer--a randomized trial.
OBJECTIVE
Endoscopic high-frequency soft coagulation is used to manage visible bleeding or nonbleeding vessels during endoscopic submucosal dissection. The aim of the present study was to compare the efficacy of hemostasis by soft coagulation (using hemostatic forceps) with argon plasma coagulation (APC), in a prospective randomized trial.


METHODS
From January 2013 to June 2014, 276 patients were randomly assigned into two groups: epinephrine injection plus APC (the APC group); or epinephrine injection plus soft coagulation using hemostatic forceps (the HFSC group). As the primary outcome we compared recurrent bleeding rates within 30 days after initial hemostasis in a noninferiority design.


RESULTS
After exclusion, 75 patients in the APC group and 76 in the HFSC group were finally evaluated. In the APC group 72 patients (96 %) were successfully treated with the assigned treatment alone vs. 73 (96 %) in the HFSC group. Initial endoscopic hemostasis using a single or combined modality was achieved in all patients. Recurrent bleeding within 30 days was experienced by five patients (6.7 %) and seven patients (9.2 %) in the AFC and HFSC groups, respectively (P = 0.563), and within 7 days by three patients (4.0 %) and five patients (6.6 %), respectively (P = 0.719). We found no significant difference in the rates of adverse events (1.3 % vs. 2.6 %) or mortality (2.7 % vs. 2.6 %) between the groups.


CONCLUSIONS
The efficacy and safety of soft coagulation using endoscopic hemostatic forceps is not inferior to APC when used to treat patients with bleeding peptic ulcers. Clinicaltrials.gov NCT02020603.
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
Jung-Wook
JW
Kim
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
Jae Young
JY
Jang
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
Chang Kyun
CK
Lee
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
Jae-Jun
JJ
Shim
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
Young Woon
YW
Chang
D000368:Aged; D057908:Argon Plasma Coagulation / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000188:drug therapy / Q000601:surgery*; D013525:Surgical Instruments; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D014662:Vasoconstrictor Agents; D004837:Epinephrine