Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline–epinephrine injection and a combination of the two for the management of bleeding peptic ulcers

Chung, Il‐Kwun; Ham, Jung-Sik; Kim, Hongsoo; Park, Sang‐Heum; Lee, Moon-Ho; Kim, Sun‐Joo

doi:10.1016/s0016-5107(99)70439-6

Cited by 185 publications

(96 citation statements)

References 20 publications

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“…This goes with others, who concluded that there was no difference in all-cause mortality irrespective of the modalities of endoscopic treatment [13,16]. Sung et al in a meta-analysis of 15 studies reported that regardless of improvements in sustaining hemostasis by clipping leading to less re bleeding and fewer interventions with surgery, mortality has not been reduced and there is no indication of a reduction in the death rate [17].…”

Section: Discussionmentioning

confidence: 70%

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Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer

Assal¹,

Elsherbiny²,

Badawy³

et al. 2010

Health

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Acute upper gastrointestinal bleeding (UGIB) remains an important emergency situation. In the last two decades, major developments took place influencing incidence, etiology and outcome of patients with acute UGIB. Peptic ulcer bleeding is the most significant complication of ulcer disease being responsible for 50% of all cases mortality. Aim of the study: To compare between endoscopic clip application versus argon plasma coagulation in management of bleeding peptic ulcer (BPU). Patients and Methods: Sixty patients suffering from acute UGIB were randomly divided into two groups: group I included 30 patients treated with endoscopic clip application and Group II included 30 patients subjected to endoscopic APC. All patients were classified according to Forrest classification and the clinical Rockall score. Results: There were significant differences between the two groups as regard Forrest classification (P < 0.05) there were insignificant difference between the two groups as regard rockall score, site of the ulcer and re bleeding (P > 0.05). Re bleeding was significant with higher Rockall score in group I (P < 0.05) but it was insignificant in group II (P > 0.05). Conclusion: Endoscopic application of hemoclips have a less re bleeding rate than Argon plasma coagulation for treatment of bleeding peptic ulcer, although this was statistically insignificant, meanwhile APC is still less cost and easy. Clinical and endoscopic assessment (through Rokcall score and Forrest classification) could help in making best choice for endoscopic management.

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Section: Discussionmentioning

confidence: 70%

“…A great care is required in performing the procedure if the bleeding ulcer is located on the posterior wall or lesser curvature of the gastric body or on the posterior wall of the duodenal bulb, the hemostatic rate is lower than for other therapies because of the technical difficulty of approaching the lesion [13].…”

Section: Discussionmentioning

confidence: 99%

Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer

Assal¹,

Elsherbiny²,

Badawy³

et al. 2010

Health

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“…The applicator is inserted through the biopsy channel of the endoscope and the metallic clips are applied directly to the visible bleeding vessel. Some studies have reported a metallic clip to be effective (20,21). However, the rate of re-bleeding or continued bleeding after endoscopic treatment is approximately 15-20% (6, 7) and this is mainly because of technical difficulties or case-based problems due to the presence of exposed arterial vessels, an ulcer with adherent clots, massive bleeding and a large ulcer with active bleeding.…”

Section: Discussionmentioning

confidence: 99%

Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

2011

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Objective: We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. Materials and Methods: In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Results: Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Conclusion: Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

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“…46 Comparative studies suggest lower re-bleeding rates than adrenaline injection, 47 ethanol 48 or saline/ adrenaline injection. 49 The additional benefit of adrenaline with a mechanical method is unclear, 50 although one randomised comparative study of combination epinephrine-polidocanol injection and Hemoclip versus Hemoclip alone for bleeding peptic ulcers showed clipping to be inferior to combination therapy. 51 Two small studies have evaluated Hemoclips for control of bleeding due to Dieulafoy's lesion, demonstrating a trend towards reduction in the need for repeat procedures.…”

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 the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline–epinephrine injection and a combination of the two for the management of bleeding peptic ulcers

Cited by 185 publications

References 20 publications

Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer

Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer

Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

Nonvariceal Upper Gastrointestinal Bleeding

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