[Comparison on Endoscopic Hemoclip and Hemoclip Combination Therapy in Non-variceal Upper Gastrointestinal Bleeding Patients Based on Clinical Practice Data: Is There Difference between Prospective Cohort Study and Randomized Study?].
OBJECTIVE
Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice.


METHODS
Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n = 62), hemoclipping only; group 2 (n = 88), hemoclipping plus epinephrine injection; and group 3 (n = 36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality.


RESULTS
Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p < 0.001). However, primary outcomes (rebleeding, other management, morbidity, hospitalization period, fasting period and mortality) and secondary outcomes (bleeding associated mortality and total mortality) were not different among groups.


CONCLUSIONS
Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice.
Departments of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Su Hyun
SH
Lee
Catholic University of Daegu School of Medicine, Daegu, Korea.
Jin Tae
JT
Jung
Catholic University of Daegu School of Medicine, Daegu, Korea.
Dong Wook
DW
Lee
Gyeongsang National University School of Medicine, Jinju, Korea.
Chang Yoon
CY
Ha
Keimyung University School of Medicine, Daegu, Korea.
Kyung Sik
KS
Park
Yeungnam University College of Medicine, Daegu, Korea.
Si Hyung
SH
Lee
Dongguk University School of Medicine, Gyeongju, Korea.
Chang Heon
CH
Yang
Soonchunhyang University College of Medicine, Gumi, Korea.
Youn Sun
YS
Park
Departments of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Seong Woo
SW
Jeon
D000328:Adult; D000368:Aged; D000792:Angiography; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016208:Databases, Factual; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D013525:Surgical Instruments; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors; D004837:Epinephrine
Endoscopic hemostasis; Gastrointestinal hemorrhage