A PROSPECTIVE RANDOMIZED TRIAL OF HEATER PROBE THERMOCOAGULATION VERSUS INJECTION THERAPY IN PEPTIC-ULCER HEMORRHAGE

Background: A prospective, randomized study was performed to compare t he hemostatic effect of injection therapy and heater probe thermocoagu lation in the treatment of peptic ulcer bleeding. Methods: This study includes 104 patients with upper gastrointestinal bleeding in whom end oscopy revealed a gastric or duodenal ulcer with nonbleeding or bleedi ng vessel (n = 66), oozing hemorrhage (n = 21), or adherent red clot ( n = 17). Patients with other stigmata or clean ulcers were excluded. P atients were randomly assigned during endoscopy to receive injection t herapy (adrenaline and polidocanol) (n = 51) or heater probe thermocoa gulation (10F probe, at setting of 30 J (n = 53). Therapy was consider ed successful if there was no further hemorrhage or only minor rebleed ing that was controlled with a second endoscopic procedure. Patients w ith major rebleeding or failure of retreatment underwent emergency sur gery. Results: There were no significant differences in effectiveness between injection therapy and thermocoagulation in any of the assessed parameters: the percentage of patients with major recurrent hemorrhag e (4% vs 6%) or minor rebleeding (16% vs 17%), need for emergency surg ery (two patients from each group), transfusion requirement (0.45 +/- 0.9 units vs 0.51 +/- 1.1 units), the mean number of hospitalization d ays (7.1 +/- 4.2 vs 6.9 +/- 4.9), and mortality (one patient from each group died). Conclusion: Injection therapy and heater probe have simi lar efficacies in the treatment of bleeding peptic ulcers.