Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer.

Abstract

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

Endoscopic Hemostasis Using Fibrin Adhesive to Treat Hemorrhage in the Upper Digestive System

“…To achieve endoscopic hemostasis of an upper gastrointestinal hemorrhage, many procedures are used, including local injections of ethanol, 7-9 polidocanol, [13][14][15] and HSE, 10-12 as well as clipping, 4-6 but each has its own disadvantages. Ethanol is used for fixation and hemostasis of a bleeding vessel because of its potent tissue fixing ability, but the alcohol component may cause the ulcerous lesion to spread after the injection, which can injure the adjacent tissue.…”

“…[1][2][3] To treat upper gastrointestinal hemorrhages, methods such as vascular clipping [4][5][6] and local injections [13][14][15] of ethanol, [7][8][9] hypertonic-saline epinephrine (HSE), [10][11][12] and other sclerosing agents [13][14][15] are commonly practiced; however, all of these methods have their own shortcomings. Clipping is done in a direction tangential to the ulcer location without a direct view of the lesion, thus limiting the efficacy of the procedure.…”

Interventional endoscopic treatment of upper gastrointestinal bleeding - when, how, and how often

“…Several studies have shown the effectiveness of injection therapy [33,34,35,36,37,38,39]. The working principle is based on application of vasoconstrictive agents around the bleeding vessel, which simultaneously causes local tamponade.…”

Les hémorragies digestives ulcéreuses au CHU Hassan-II de Fès: approche épidémiologique

“…La récidive hémorragique était définie par la présence d'un des éléments suivants [9] : survenue d'une nouvelle hématémèse ou d'un melaena après une selle normale ; extériorisation d'un melaena associée à des modifications hémodynamiques (fréquence cardiaque supérieure à 100 par minute et pression artérielle systolique inférieure à 100 mmHg) [7,[10][11][12] ; persistance d'un melaena, avec nécessité de transfusions sanguines pour maintenir un hématocrite supérieur à 30 % [7] ; extériorisation d'un melaena associée à une chute de l'hémoglobine de plus de deux points en 24 heures [10][11][12] ; anomalies hémodynamiques isolées (pression artérielle systolique inférieure à 100 mmHg ou chute supérieure à 50 mmHg).…”