Endoscopic injection therapy for bleeding peptic ulcer; a comparison of adrenaline alone with adrenaline plus ethanolamine oleate.

Choudari, C. P.; Palmer, K R

doi:10.1136/gut.35.5.608

Cited by 80 publications

(38 citation statements)

References 11 publications

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“…In a small study of 32 patients with bleeding ulcers, Histoacryl injection was no more effective than injection with dilute adrenaline. 25 More recently, Lee et al demonstrated significantly lower re-bleeding rate for patients with Forrest type Ia lesions treated with Histoacryl compared to injection with hypertonic saline-adrenaline injection. 36 However, there was no overall benefit in the use of Histoacryl with regards to haemostasis rates, emergency surgery or mortality.…”

Section: Endoscopic Managementmentioning

confidence: 99%

“…24 Although injection with adrenaline is successful in achieving initial haemostasis, 15-36% of patients rebleed, a figure that is unacceptably high. 25,26 Sclerosants such as ethanol, polidocanol and ethanolamine are equally effective as adrenaline but carry more risk. 25,[27][28][29] In one study, ethanol injection alone was shown to have a re-bleeding rate as low as 4%; 30 however, most other published studies have achieved similar haemostasis to adrenaline alone.…”

Section: Endoscopic Managementmentioning

confidence: 99%

“…25,26 Sclerosants such as ethanol, polidocanol and ethanolamine are equally effective as adrenaline but carry more risk. 25,[27][28][29] In one study, ethanol injection alone was shown to have a re-bleeding rate as low as 4%; 30 however, most other published studies have achieved similar haemostasis to adrenaline alone. Combination therapy with adrenaline and ethanol may improve haemostasis and shorten hospital stay for patients with spurting haemorrhage.…”

Section: Endoscopic Managementmentioning

confidence: 99%

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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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Section: Endoscopic Managementmentioning

confidence: 99%

Section: Endoscopic Managementmentioning

confidence: 99%

Section: Endoscopic Managementmentioning

confidence: 99%

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Nonvariceal Upper Gastrointestinal Bleeding

Ferguson

Mitchell²

2004

Endoscopy

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“…15,16 Furthermore, endoscopic treatment utilizing an adrenaline injection of 1:10,000 or a heater probe has proven effective in the majority of patients. [16][17][18] Mortality associated with peptic ulcer bleeding ranges from 4% to 10%. 15,19 In the present study, nine (64%) bleeding patients ceased spontaneously while five responded to endoscopic management.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Peptic Ulcers in Patients with Portal Hypertension

Amri

1995

Annals of Saudi Medicine

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To find the frequency of peptic ulceration in portal hypertension, 137 patients with portal hypertension were studied retrospectively. Patients with hepatocellular carcinoma, other malignancies or underlying severe systemic disease were excluded and the remaining 114 patients were included in the study. There were 81 males (mean age 49.1 ± 13.7 years) and 33 females (mean age 52.9 ± 10 years). Portal hypertension was secondary to viral liver disease in 75%. Fifty-seven patients had no evidence of peptic ulcers (group I) and another 57 patients (group II) had peptic ulcers diagnosed during upper gastrointestinal endoscopy. There was no significant difference between the two groups regarding age, sex, Child-Pugh score or variceal size. Duodenal ulcers were found in 24% while gastric ulcers were found in 4.4%; other endoscopic findings included erosive gastritis and duodenitis in 21% and 18.4% respectively. Twelve percent of the patients from group II developed bleeding from the ulcers and the majority of bleeding ulcers responded to conservative treatment. The study concludes that the frequency of peptic ulcers in patients with portal hypertension is high. Bleeding peptic ulcers respond to conservative treatment. Ann Saudi Med 1995;15 (5) The incidence of peptic ulcer disease in cirrhotic patients has been reported to range from 8% to 20%.1-4 The complication rate and mortality are also increased in such patients.1 Suggested pathogenesis of peptic ulcers in patients with cirrhosis includes increased levels of gastrin and histamine, the presence of Helicobacter pylori, increased duodenogastric reflux, impaired gastric emptying, reduced prostaglandin level in gastric mucosa and reduced mucosal oxygen saturation. 1,[5][6][7][8][9] Most of the former studies have been performed in alcoholic-related etiologies, mainly liver cirrhosis. 10Therefore, we conducted our study to find out the frequency of peptic ulcer disease in patients with portal hypertension of different etiologies, mainly nonalcoholic. Patients and MethodsOne hundred and thirty-seven consecutive patients with portal hypertension diagnosed at the Gastroenterology Unit of King Khalid University Hospital between AH 1413 to AH 1414 were included. Twenty-three patients subsequently were excluded because of the presence of hepatocellular carcinoma, gastric carcinoma or severe systemic disease such as end stage renal failure or end stage respiratory and cardiac disease.The remaining 114 patients entered the study. There were 81 males (mean age 49.1 ± 13.7 years) and 33 females (mean age 52.9 ± 10 years). The diagnosis of portal hypertension was based on the presence of prominent submucosal veins that protrude into the esophageal lumen. Esophageal varices were graded on a scale from 1 to 4 according to size. The diagnosis of portal hypertension was substantiated with upper abdominal ultrasonography. An ulcer was defined as the presence of an ulcer crater.The patient's history was reviewed regarding the presence of abdominal pain, hematemesis or melena, smoking h...

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“…This allows achieving primary haemostasis in 95% of the patients with the expected rebleeding rate of 15-20% of the patients (19). The addition of sclerosing substances contributes to the increased incidence of complications in the form of inflammatory injury to the gastrointestinal wall without a clear effect on the effectiveness of haemostasis (20)(21)(22)(23). Meta-analyses comparing the efficacy of individual injection methods failed to demonstrate the superiority of any one method over the other (24,25).…”

Section: Endoscopic Diagnosis and Treatmentmentioning

confidence: 99%