Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding

Abstract

Background-Peptic ulcers with active bleeding or a non-bleeding visible vessel require aggressive endoscopic treatment. Aims-To determine whether endoscopic adrenaline injection alone or contact probe therapy following injection is a suitable treatment for peptic ulcer bleeding. Methods-A total of 96 patients with active bleeding or non-bleeding visible vessels received adrenaline alone, bipolar electrocoagulation alone, or combined treatment (n=32 in each group). Results-Initial haemostasis was not achieved in one patient in the adrenaline group, two in the gold probe group, and two in the injection gold probe group (p>0.1). Rebleeding episodes were fewer in the injection gold probe group (2/30, 6.7%) than in the gold probe group (9/30, 30%, p=0.04) and in the adrenaline group (11/31, 35.5%, p=0.01). Treatment failure (other therapy required) was rarer in the injection gold probe group (4/32, 12.5%) than in the adrenaline group (12/32, 37.5%, p=0.04). The volume of blood transfused after entry of the study was less in the injection gold probe group (mean 491 ml) than in the adrenaline group (1548 ml, p<0.0001) and the gold probe group (1105 ml, p<0.01). Duration of hospital stay, numbers of patients requiring urgent surgery, and death rate were not statistically diVerent among the three groups. Conclusions-For patients with peptic ulcer bleeding, combined adrenaline injection and gold probe treatment oVers an advantage in preventing rebleeding and decreasing the need for blood transfusion.

Management of Patients With Ulcer Bleeding

“…Results of two small studies suggested benefi t of epinephrine plus bipolar electrocoagulation vs. bipolar electrocoagulation alone, but results with thermal monotherapy were poorer in these trials than most other studies ( 69,70 ). A larger high-quality study found that injection of thrombin plus heater probe was not better than heater probe alone ( 71 ).…”

Endoscopic dual versus monotherapy in patients bleeding from high-risk peptic ulcers

“…Moreover, by inspecting the Forrest plots for rebleeding in the meta-analyses, it should be noted that only 5 of 22 studies registered significantly different results between the 2 endoscopic strategies. [18][19][20][21][22] This would indicate that there was significant heterogeneity among the studies concerning recurrent bleeding. Marmo et al [14] handled this heterogeneity by subgroup analysis and meta-regression, and found that the type of dual therapy applied and the post-hemostasis adjuvant therapy with PPIs could explain the heterogeneity.…”

“…Marmo et al [14] handled this heterogeneity by subgroup analysis and meta-regression, and found that the type of dual therapy applied and the post-hemostasis adjuvant therapy with PPIs could explain the heterogeneity. The applicability of the meta-analysis by Calvet et al [13] could be limited by the fact that only a single study used omeprazole as adjuvant treatment, [20] presently considered as "modern" anti-secretory therapy. A much more valuable interpretation of their results would indicate that dual therapy was superior to epinephrine monotherapy when medical therapy other than PPIs was given.…”

“…Contrariwise, when we administered adjuvant PPIs after endoscopic hemostasis, epinephrine monotherapy proved as effective as in combination with thermal therapy. A single randomized study on patients with peptic ulcer bleeding that used adjuvant PPIs and compared epinephrine monotherapy with epinephrine plus thermal therapy is available: [20] rebleeding episodes were fewer in the combination group (2 of 30, 6.7%) than in the monotherapy group (11 of 31, 35.5%). However, the generalizability of data from this study may be questionable because of its small sample size.…”

Modalidades De Terapia Endoscópica Frente À Hemorragia Digestiva Alta Não-Varicosa

“…Novamente, o grupo em que houve a associação dos métodos apresentou uma menor taxa de ressangramento ( 6% versus 30% versus 35.5%). 19 Bianco et al em um ensaio randomizado (n = 114) demonstrou que a combinação de epinefrina e termocoagulação bipolar apresenta um melhor controle inicial do sangramento e do volume de transfusão, quando comparada à injeção isolada. 20 Bardou et al em 2003 afirmou a equivalência entre quaisquer métodos de termocoagulação, quando isolados.…”