ENDOSCOPIC INJECTION FOR BLEEDING PEPTIC-ULCER - A COMPARISON OF ADRENALINE ALONE WITH ADRENALINE PLUS HUMAN THROMBIN

Background & Aims: Endoscopic injection therapy improves outcome in bl eeding peptic ulcer, but the optimum regimen is unknown, The aim of th is study was to compare the efficacy of endoscopic therapy with dilute adrenaline alone vs, adrenaline plus human thrombin in the treatment of patients with major peptic ulcer hemorrhage. Methods: One hundred f orty patients with significant peptic ulcer hemorrhage and active arte rial bleeding or a nonbleeding visible vessel were randomized to endos copic injection with 1:100,000 adrenaline (70 patients; group 1) or to adrenaline plus 600-1000 IU of human thrombin (70 patients; group 2), The two groups were well matched for age, shock, hemoglobin concentra tion, comorbid disease, endoscopic findings, and consumption of nonste roidal antiinflammatory drugs, Results: Fourteen patients from group 1 (20%) and 3 patients from group 2 (4.5%) rebled (P < 0.005), Seven pa tients from group 1 (10%) but no patients from group 2 died within 30 days of admission (P < 0.013), Patients from group 1 were administered a total of 297 units of blood compared with 219 units in group 2 (P < 0.041). Conclusions: Endoscopic injection using adrenaline plus human thrombin is superior to injection with dilute adrenaline alone and ma y represent the best treatment for bleeding peptic ulcers.