Peptic ulcer bleeding: Comparison of two hemostatic procedures

OBJECTIVE: Bleeding is a serious complication of peptic ulcer. Endoscopic i njection therapy is accepted as a homeostatic endoscopic treatment in acute nonvariceal of upper GI hemorrhages, particularly in bleeding peptic ulcer s. The risk of rebleeding is predicted by the endoscopic appearance of ulce r features classified according to Forrest's criteria. METHODS: Two hundred twenty-three patients were selected from 1,003 emergen cy upper endoscopies for GI bleeding. According to Forrest's criteria, 99 w ell-matched patients with ulcers F1 and F2 were considered at risk of reble eding; 54 patients (group A) received local ulcer injection of epinephrine solution 1:10,000, whereas (group B) patients were treated with local epine phrine injection and then with endoscopic Hemoclips.(1) We considered the c ontrol of bleeding, the number of rebleeding episodes, the need for emergen cy surgery, and mortality. RESULTS: Bleeding ulcers stopped completely in 83.3% group A patients, and in 95.6% group B patients (p = not significant). In a subset of F1b patient s the rebleeding rate was 31% for group A and 0% for group B (p < 0.05). Th ere was no mortality as a result of the procedure. There was a trend toward reducing surgery in favor of the combined therapy (0% vs 7.4%). No differe nces were found in transfusion requirements or mean hospitalization days. CONCLUSIONS: We conclude that endoscopic injection of 1:10,000 epinephrine solution alone and epinephrine solution plus application of Hemoclips are e quivalent therapies in treating bleeding and rebleeding from peptic ulcers. There was no difference between therapies in terms of need for surgery or mortality. Possibly combination therapy is more effective in treating ulcer s that are actively oozing. (Am J Gastroenterol 2001;96:89-94. (C) 2001 by Am. Coll. of Gastroenterology).