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Gastrointest Endosc. 2006 May;63(6):767-73.

Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers.

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  • 1Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan.

Abstract

BACKGROUND:

Rebleeding occurs in 10% to 30% of bleeding ulcer patients receiving endoscopic epinephrine injection therapy. It remains unclear whether addition of a secondary clip therapy following epinephrine injection may reduce the rebleeding rate of high-risk bleeding ulcers.

OBJECTIVE:

To compare the efficacies of epinephrine injection alone and epinephrine injection combined with hemoclip therapy in treating high-risk bleeding ulcers.

DESIGN:

Prospective randomized controlled trial.

SETTING:

A medical center in Taiwan.

PATIENTS:

One hundred five bleeding ulcer patients with active spurting, oozing, nonbleeding visible vessels or adherent clots in ulcer bases.

INTERVENTIONS:

Endoscopic combination therapy (n = 52) or diluted epinephrine injection alone (n = 53).

MAIN OUTCOME MEASUREMENTS:

Initial hemostasis rates and recurrent bleeding rates.

RESULTS:

Initial hemostasis was achieved in 51 patients treated with combination therapy and 49 patients with epinephrine injection therapy (98% vs 92%, P = .18). Bleeding recurred in 2 patients in the combination therapy group and 11 patients in the epinephrine injection group (3.8% vs 21%, P = .008). Among the patients with rebleeding, repeated combination therapy was more effective than repeated injection therapy in achieving permanent hemostasis (100% vs 33%, P = .02). No patient required an emergency operation in the combination therapy group. However, 5 patients in the epinephrine injection group underwent emergency surgery to arrest bleeding (0% vs 9%, P = .023).

LIMITATIONS:

Treatment outcome of endoscopic hemoclip therapy is related to the techniques of endoscopists.

CONCLUSION:

Endoscopic combination therapy is superior to epinephrine injection alone in the treatment of high-risk bleeding ulcers.

PMID:
16650535
[PubMed - indexed for MEDLINE]
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