A controlled trial of bipolar electrocoagulation in patients with upper gastrointestinal bleeding

Abstract

We have assessed the value of the BICAP electrocoagulation probe in reducing the incidence of further bleeding in patients with upper gastrointestinal haemorrhage. One hundred and twenty-nine patients were studied in a prospective randomized controlled trial. There were 85 male and 44 female patients, age range 16-92 years. Forty-five patients had stigmata of recent haemorrhage (visible vessel or spot) and were randomized during endoscopy to 24 control and 21 treatment patients. Seven control patients rebled compared with nine treated patients (Fisher's exact probability test P = 0.44). The transfusion requirements of control patients (3.9 +/- 3.2 units) was not different from that of treated patients (5.7 +/- 3.7 units): Mann Whitney U test, P = 0.06. In the treatment group there was no difference in the operation rate. Also, the number of probe applications between patients with further bleeding and those with no further bleeding was similar (11.6 +/- 5.5 and 11.0 +/- 5.75 respectively). Access with the probe was considered inadequate in 50 per cent of lesions, but this did not correlate with the incidence of rebleeding. Stigmata of recent haemorrhage were significant in predicting rebleeding (P = 0.0019 Fisher's exact probability test). Overall mortality rate of 3.2 per cent was low and was not influenced by electrocoagulation or presence of stigmata of recent haemorrhage. We have not shown that BICAP bipolar electrocoagulation reduces the incidence of rebleeding in upper gastrointestinal haemorrhage.

Combining information from independent sources through confidence distributions

“…Efron [(1993), Section 5] studied an example of combining independent studies. The example concerns a randomized clinical trial studying a new surgical treatment for stomach ulcers [Kernohan, Anderson, McKelvey and Kennedy (1984)] in which there are 9 successes and 12 failures among 21 patients in treatment groups, and 7 successes and 17 failures among 24 patients in the control group. The parameter of interest is the log odds ratio of the treatment.…”

Endoscopic management of nonvariceal gastrointestinal bleeding

“…Other series have not been as positive [70]. A randomized trial [71] in a group of patients with ulcers displaying SRH showed no benefit in terms of rebleeding, surgery, transfusion, or mortality. The authors also noted difficulty in accessing 50% of the lesions, although others have found BICAP easier to apply, even tangentially [69].…”

Acute Gastrointestinal Bleeding

“…However, because of tissue adhering to the probe, it can incite further bleeding, and the depth of tissue burn cannot be well controlled. Bipolar cautery has recently been used for GI bleeding [67,68]. With this technique the current runs only at the tip of the probe and not through the patient to a ground, as with monopolar cautery.…”