INJECTION OF FIBRIN TISSUE ADHESIVE VERSUS LASER PHOTOCOAGULATION IN THE TREATMENT OF HIGH-RISK BLEEDING PEPTIC-ULCERS - A CONTROLLED RANDOMIZED STUDY

Background and Study Aims: A controlled and randomized multicenter stu dy was carried out in order to compare the efficacy of fibrin sealant and Nd:YAG laser photocoagulation in patients with high-risk arterial bleeding from peptic ulcers of the stomach and the small intestine. Pa tients and Methods: In four teaching hospitals, 53 patients presenting with either active arterial ulcer bleeding (Forrest class 1 a) or a l arge visible vessel in the ulcer base (diameter over 2 mm, Forrest cla ss 2 a) were treated with infiltration of epinephrine 1:10,000 followe d by the injection of fibrin tissue adhesive (n=28), or with epinephri ne plus laser photocoagulation (n=25), Permanent hemostasis for at lea st seven days served as the principal end point; rebleeding, emergency surgery, and hospital mortality served as further end points. Results : There were no significant differences between the study groups in te rms of age, risk factors, initial hemoglobin values, number of patient s showing signs of hemodynamic impairment, ulcer size and localization , or bleeding activity, Primary hemostasis was achieved in all patient s, Rebleeding rates were seven of 28 and four of 25 among the patients treated with fibrin sealant and laser coagulation, respectively (not significant), There were no significant differences regarding the rate s of ultimate hemostasis (24 of 28 vs, 24 of 25), emergency surgery (f our of 28 vs, one of 25), or hospital mortality (0 vs, two of 25), No complications occurred with either form of treatment, Patients who had a visible vessel in the ulcer floor at the first control endoscopy ha d a significantly higher incidence of rebleeding, regardless of the ty pe of endoscopic therapy. Conclusions: We conclude that both the injec tion of fibrin tissue adhesive and laser photocoagulation are effectiv e methods of treating high-risk arterial peptic ulcer bleeding, As the number of high-risk patients necessary to reach significance are diff icult to recruit within a reasonable period even in a multicenter stud y, a new meta-analysis of all studies now available should be consider ed.