Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial

Background: Endoscopic application of hemoclips (HC) was prospectively comp ared with heat probe (HP) treatment in patients with bleeding ulcers. Methods: One hundred thirteen patients with major stigmata of ulcer hemorrh age were randomly assigned to receive HP (n = 57) or HC (n = 56). Clinical and endoscopic features were comparable in both groups. Recurrent bleeding was retreated with the modality previously used. Patients in whom treatment or retreatment was unsuccessful underwent emergency surgery. Results: Hemostasis, adequate treatment of visible vessel, 30-day mortality , and emergency surgery rates were similar for both groups. Recurrent bleed ing was 21% for HP and 1.8% for HC (p < 0.05). Length of hospital stay and transfusion requirements were significantly lower in the HC group. There wa s no evidence of clip-induced tissue injury or impaired ulcer healing. Clip s dislodged spontaneously in most patients within 8 weeks of treatment. No further hemorrhage occurred on a median follow-up of 11 months (range 1-23) . Conclusions: The hemoclip is safe and effective in the treatment of severe ulcer bleeding and is superior to HP in preventing early recurrent bleeding .