COMPARISON OF INJECTION SCLEROTHERAPY AND LASER PHOTOCOAGULATION FOR BLEEDING PEPTIC-ULCERS

Background and Study Aims: The most widely used endoscopic procedures in the management of patients with bleeding peptic ulcer are at presen t sclerotherapy and thermal methods. In an attempt to assess the most effective method of achieving hemostasis, we compared injection sclero therapy and laser photocoagulation in terms of the efficacy of initial hemostasis, rebleeding, need for surgery, mortality, and the appearan ce of the ulcer after the hemostatic procedure. Patients and Methods: In this prospective, randomized trial, 160 patients were treated with injection sclerotherapy (1% polidocanol), and 155 patients with laser photocoagulation (Nd:YAG laser) in cases of Forrest I, Forrest IIa, an d Forrest IIb hemorrhage. The bleeding activity was classified accordi ng to the modified Forrest criteria. Polidocanol injection and Nd:YAG laser photocoagulation were not preceded by epinephrine administration . Results: There were no significant overall differences between the g roups in the outcome in terms of definitive hemostasis, rebleeding, ur gent surgery, and death (p = 0.487). In the case of the subgroup with Forrest I lesions, laser photocoagulation was more efficacious than sc lerotherapy (p = 0.0078), In the Forrest IIa and Forrest IIb subgroups , the two methods were equally effective (p = 0.202 and 0.513 respecti vely). In the sclerotherapy patients, definitive initial hemostasis in Forrest IIa was achieved in 100%, whereas in the laser group this rat e was 92%, with 28% of patients initially developing hemorrhage after one or two laser pulses, Ulcer healing was slower following sclerother apy than after photocoagulation. Conclusion: Injection sclerotherapy a nd laser photocoagulation are equally effective in achieving definitiv e hemostasis in bleeding peptic ulcers, Laser photocoagulation is more efficacious in patients with active bleeding, whereas injection scler otherapy is more effective in patients with a nonbleeding visible vess el.