Endoscopic injection therapy vs. multipolar electrocoagulation vs. laser vs. injection plus octreotide vs. injection plus omeprazole in the treatmentof bleeding peptic ulcers. A prospective randomized study

Background Aims: A prospective randomized study was performed to assess the effectiveness and safety of 5 different methods of hemostasis in selected patients with high-risk bleeding peptic ulcers. Methodology: Two hundred and eight patients (n=208; mean age: 61.6 yrs) wit h endoscopic stigmata of active hemorrhage, non-bleeding vessel or adherent fresh clot were randomized during emergency endoscopy to receive one of th e following modalities of endoscopic therapy (with or without pharmacologic al therapy): I) injection of absolute alcohol (n=44); II) multipolar electr ocoagulation (BICAP(TM); n=42); III) Nd-YAG laser (n=40); IV) injection of absolute ethanol+octreotide (n=42); V) injection of absolute ethanol+omepra zole (n=40). Results: The 5 treatment groups were clinically and endoscopically comparab le. The initial hemostatic success was >90% in every group. No significant differences between groups were found in any of the following parameters as sessed during hospitalization: incidence of rebleeding (I=14.8% vs. II=19.0 % vs. III=16.6% vs. IV=18.1% vs. V=20.0%; P>0.05 mean=17.7%); incidence of definitive hemostasis (I=89.3% vs. II=85.1% vs. III=86.6% vs. IV=84.0% vs. V=86.6%; P>0.05; mean=86.5%); incidence of emergency surgery (I=8.5% vs. II =11.9% vs. III=10.0% vs. IV=6.8% vs. V=11.1%; P>0.05; mean=9.6%); mortality rate (I=4.2% vs. II=4.7% vs. III=3.3% vs. IV=13.6% vs. V=4.4%; P>0.05; mea n=6.2%). Mean age of deceased patients was significantly higher than living patients (71.2+/-13.4 vs. 60.9+/-14.4; P<0.05). Approximately 2/3 of the f atal cases were strongly weakened by coexistent medical diseases. The durat ion of hospital stay was similar for all groups. The BICAP(TM) group requir ed less units of blood transfusion (1.9+/-1.8 vs. I=3.0+/-2.6; III=3.5+/-3. 6; IV=2.8+/-2.3; V=3.1+/-2.5; P<0.05), perhaps due to the higher mean value of hemoglobin of these patients at hospital admission, compared to all oth er groups. No significant complications were reported. Conclusions: This study provides good evidence that injection of absolute e thanol, multipolar electrocoagulation (BICAP(TM)) and Nd-YAG laser are equa lly safe and effective in the endoscopic therapy of acute bleeding peptic u lcers. In contrast, no additional hemostatic benefits arose from the associ ation of pharmacological agents (octreotide or omeprazole) to sclerosis inj ection.