Comparison of Endoscopic Polidocanol Injection and Yag Laser Therapy for Bleeding Peptic Ulcers

Rutgeerts, Paul; Broeckaert, L; Janssens, J; Vantrappen, Gaston; Coremans, Georges; Hiele, Martin

doi:10.1016/s0140-6736(89)92751-7

Cited by 117 publications

(35 citation statements)

References 12 publications

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“…Altogether 109 fulfilled the entry criteria and were randomised to the study. Forty four patients were excluded because they had no endoscopic stigmata of recent haemorrhage, although they had apparently bled from a peptic ulcer, 19 had other causes of bleeding (varices (n=3), gastritis (n=2), carcinoma (n=3), aortoduodenal fistula (n=2), oesophagitis (n=3), Mallory Weiss tear (n=6), no cause (n= 3)), and eight patients had inaccessible ulcers, principally within awkwardly deformed duodenal caps.…”

Section: Patientsmentioning

confidence: 99%

Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer.

Rajgopal

Palmer

1991

Gut

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One hundred and nine patients presenting with severe haemorrhage from benign peptic ulcers were randomised to either endoscopic injection sclerotherapy using a combination of 1:100000 adrenaline and 5% ethanolamine or to conservative treatment. Only high risk patients with active bleeding or endoscopic stigmata of recent haemorrhage and accessible ulcers were considered. The two groups were well matched for age, shock, haemoglobin concentration, endoscopic findings, and consumption of non-steroidal anti-inflammatory drugs. The group treated endoscopically had a significantly reduced rebleeding rate (12.5% v 47%, p<0.001). Rebleeding was successfully treated in some patients by injection sclerotherapy, other patients underwent urgent surgery. While there was a tendency towards a lower operation rate and lower transfusion requirements in the treated group, this failed to achieve statistical significance. The use of injection sclerotherapy in the conservatively treated group after rebleeding undoubtedly reduced the number of surgical operations. Endoscopic injection sclerotherapy is effective in the prevention of rebleeding in these patients.Bleeding peptic ulcer can be treated by a range of endoscopic techniques including Nd-Yag laser photocoagulation,`2 the heater probe,34 bipolar,56 or monopolar78 electrodes. These modalities tend to be expensive, require highly trained assistance and technical back up, and are not widely used. Recent attention has focused upon injection sclerotherapy of the bleeding area using adrenaline alone,9 a sclerosant alone,'0`or

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Section: Patientsmentioning

confidence: 99%

Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer.

Rajgopal

Palmer

1991

Gut

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“…The only comparative study (29) was well designed and gave excellent results for both Y AG laser and bipolar; both groups were preinjected with adrenaline. Subsequent studies (52,53) have shown that adrenaline mjectinn alone 1s effective in reducing furrher bleeding from peptic ulcers, although the combinatton of adrenaline and a thermal method achieved better results.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent stuJies (53,54) also looked at a combination of mjection wuh adrenaline and a sclcrosant (Polidocanol, Mcthoxysclerol l %, Germany).…”

Section: Discussionmentioning

confidence: 99%

Review of Endoscopic Thermal Treatment of Peptic Ulcer Hemorrhage

Sargeant¹,

Loizou²,

Bown³

1990

Canadian Journal of Gastroenterology

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Peptic ulcer hemorrhage is still an important cause of emergency surgery and death. The overall mortality is around 10% from gastrointestinal bleeding, and most of the preventable deaths occur in elderly patients with continued or recurrent bleeding from peptic ulcers. An effective nonsurgical method of hemostasis has long been recognized to be desirable. However it was only when the 'visible vessel' was recognized as the important risk facto r for further bleeding that studies capable of testing new modalities adequately could be performed. Careful wa:;hing of the ulcer crater is essential for identification of ,hese visible vessels. An effective endoscopic method was first demonstrated in 1981 in patients with visible vessels treated with argon laser. Many groups have now shown excellent efficacy of neodymium:yttrium-aluminum-garnet (NdY AG) laser in preventing further hemorrhage from ulcers with bleeding and nonbleeding visible vessels. Two controlled prospective studies have demonstrated efficacy of the heater probe, but one well designed study did not. Similar studies with both bipolar and monopolar electrocoagulation have shown significant reductions in rebleeding in patients with visible vessels treated using the chosen modality. More recent studies have achieved excellent results by pre-injection with adrenaline and one repeat endoscopic treatment for rebleeds.A few groups have now reported equally good results with injection alone. Long term follow-up of patients with peptic ulcer hemorrhage has confirmed prolonged hemostasis in groups treated with two thermal modalities and in controls. Can J Gastroenterol 1990;4(9):653-662

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“…38 A larger prospective randomised study of dual therapies for bleeding peptic ulcers showed no significant difference in primary haemostasis, procedure duration, re-bleeding, requirement for surgery, 30-day mortality or ulcer healing at 8 weeks between treatment with adrenaline and heater probe versus adrenaline and APC. 39 ND:YAG laser therapy has been shown to be as effective than injection with adrenaline-polidocanol, 40 but, due to technical constraints of the technique, laser therapy is not routinely used in the management of non-variceal UGIB.…”

Section: Endoscopic Managementmentioning

confidence: 99%

Nonvariceal Upper Gastrointestinal Bleeding

Ferguson

Mitchell²

2004

Endoscopy

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A study in the Netherlands examined recent time trends in the incidence and outcome of upper gastrointestinal bleeding between the periods 1993-94 and 2000 [1]. The incidence of acute upper gastrointestinal bleeding decreased from 61.7 per 100 000 in 1993-94 to 47.7 per 100 000 persons annually in 2000, corresponding to a 23 % decrease in the incidence after age adjustment (95 % CI, 15 % to 30 %). Despite more frequent use of combination treatment, more frequent endoscopic interventions to treat ulcers with adherent clots, and a higher rate of protonpump inhibitor (PPI) use in the second period, the rebleeding rate (16 % vs. 15 %) and mortality rate (14 % vs. 13 %) did not differ between the two periods. Ulcer bleeding remained the most frequent cause of bleeding, at 40 % (1993-94) and 46 % (2000). Almost half of all patients with peptic ulcer bleeding were using nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin. Re-bleeding was similarly high among patients with peptic ulcer bleeding in both groups (20 % and 22 %, respectively). Increasing age, presence of severe comorbidities, and rebleeding were associated with higher mortality. An analysis of secular trends in hospitalization and mortality rates from peptic ulcer disease, upper gastrointestinal bleeding, and any gastrointestinal bleeding was published using data from the National Hospital Discharge Survey [2]. These rates were compared with sales of NSAIDs, aspirin, and acid-suppression medications from 1992 to 1999. Annual rates of hospitalization and mortality per 100 000 population for peptic ulcer disease declined from 205 to 165 and 7.7 to 6.0, respectively; the calendar year correlated negatively with both peptic ulcer disease hospitalization rates (P = 0.007) and mortality rates (P = 0.058). Sales of acid-suppression medications correlated negatively with peptic ulcer disease hospitalization rates (P = 0.037) and mortal

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Comparison of Endoscopic Polidocanol Injection and Yag Laser Therapy for Bleeding Peptic Ulcers

Cited by 117 publications

References 12 publications

Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer.

Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer.

Review of Endoscopic Thermal Treatment of Peptic Ulcer Hemorrhage

Nonvariceal Upper Gastrointestinal Bleeding

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