Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two forthe management of bleeding peptic ulcers

Background: The endoscopic hemoclip method is a safe and effective hemostat ic method for managing bleeding peptic ulcers. We compared the hemostatic e fficacy of the endoscopic hemoclip method with that of hypertonic saline-ep inephrine (HSE) injection and a combined method in the management of bleedi ng peptic ulcers. Methods: From July 1994 to July 1997, we conducted a randomized clinical tr ial of endoscopic hemostasis involving 124 patients with actively bleeding or visible vessels at endoscopic inspection. Results: Patients were randomly assigned to hemoclip (41 patients), HSE (41 patients), and combined treatment groups (42 patients). Initial hemostasis was achieved in 97.6%, 95.1%, and 97.6% of cases, respectively. Recurrent bleeding developed in 2.4%, 14.6%, and 9.5% of cases. Emergency operations were performed in 4.9%, 14.6%, and 2.3% of cases. The hemostasis rate was 7 1.4%, 50%, and 66.7% for spurting hemorrhage in each group. Permanent hemos tasis was achieved in 95.1%, 85.4%, and 95.2% of cases. Three patients had complications, all in the HSE group. Conclusions: The hemoclip method is an effective hemostatic procedure and i s safer than HSE injection. The combined method does not provide substantia l advantage over use of the hemoclip method alone in the hemostatic managem ent of bleeding peptic ulcers.