Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding

Ljubičić, Neven and Budimir, Ivan and Bišćanin, Alen and Nikolić, Marko and Supanc, Vladimir and Hrabar, Davor and Pavić, Tajana (2012) Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding. World Journal of Gastroenterology, 18 (18). pp. 2219-24. ISSN 1007-9327

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© 2012 Baishideng. All rights reserved. ----- AIM: To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer. ----- METHODS: Between January 2005 and December 2009, 150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed (Forrest IIa) were included in the study. Patients were randomized to receive a small-volume epinephrine group (15 to 25 mL injection group; Group 1, n = 50), a large-volume epinephrine group (30 to 40 mL injection group; Group 2, n = 50) and a hemoclip group (Group 3, n = 50). The rate of recurrent bleeding, as the primary outcome, was compared between the groups of patients included in the study. Secondary outcomes compared between the groups were primary hemostasis rate, permanent hemostasis, need for emergency surgery, 30 d mortality, bleeding-related deaths, length of hospital stay and transfusion requirements. ----- RESULTS: Initial hemostasis was obtained in all patients. The rate of early recurrent bleeding was 30% (15/50) in the small-volume epinephrine group (Group 1) and 16% (8/50) in the large-volume epinephrine group (Group 2) (P = 0.09). The rate of recurrent bleeding was 4% (2/50) in the hemoclip group (Group 3); the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution (P = 0.0005 and P = 0.045, respectively). Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups. ----- CONCLUSION: Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.

Item Type: Article
MeSH: Adult ; Aged ; Aged, 80 and over ; Blood Transfusion ; Chi-Square Distribution ; Combined Modality Therapy ; Croatia ; Duodenal Ulcer/mortality ; Duodenal Ulcer/therapy ; Epinephrine/administration & dosage ; Epinephrine/adverse effects ; Equipment Design ; Female ; Hemostasis, Endoscopic/adverse effects ; Hemostasis, Endoscopic/instrumentation ; Hemostasis, Endoscopic/mortality ; Hemostatics/administration & dosage ; Hemostatics/adverse effects ; Humans ; Injections ; Length of Stay ; Male ; Middle Aged ; Peptic Ulcer Hemorrhage/mortality ; Peptic Ulcer Hemorrhage/therapy ; Prospective Studies ; Recurrence ; Stomach Ulcer/mortality ; Stomach Ulcer/therapy ; Surgical Instruments ; Time Factors ; Treatment Outcome
Departments: Katedra za internu medicinu
Depositing User: Marijan Šember
Status: Published
Ljubičić, NevenUNSPECIFIED
Supanc, VladimirUNSPECIFIED
Date: 14 May 2012
Date Deposited: 13 Feb 2014 10:55
Last Modified: 13 Feb 2014 10:55
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/2045

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