Gastrointestinal endoscopy · 2006
Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers.
Сравнительное исследованиеСтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Lo Ching-Chu, Hsu Ping-I, Lo Gin-Ho, Lin Chiun-Ku, Chan Hoi-Hung, Tsai Wei-Lun, Chen Wen-Chi, Wu Chung-Jen, Yu Hsien-Chung, Cheng Jin-Shiung, Lai Kwok-Hung
Аннотация
BACKGROUND: Rebleeding occurs in 10% to 30% of bleeding ulcer patients receiving endoscopic epinephrine injection therapy. It remains unclear whether addition of a secondary clip therapy following epinephrine injection may reduce the rebleeding rate of high-risk bleeding ulcers.
OBJECTIVE: To compare the efficacies of epinephrine injection alone and epinephrine injection combined with hemoclip therapy in treating high-risk bleeding ulcers.
DESIGN: Prospective randomized controlled trial.
SETTING: A medical center in Taiwan.
PATIENTS: One hundred five bleeding ulcer patients with active spurting, oozing, nonbleeding visible vessels or adherent clots in ulcer bases.
INTERVENTIONS: Endoscopic combination therapy (n = 52) or diluted epinephrine injection alone (n = 53).
MAIN OUTCOME MEASUREMENTS: Initial hemostasis rates and recurrent bleeding rates.
RESULTS: Initial hemostasis was achieved in 51 patients treated with combination therapy and 49 patients with epinephrine injection therapy (98% vs 92%, P = .18). Bleeding recurred in 2 patients in the combination therapy group and 11 patients in the epinephrine injection group (3.8% vs 21%, P = .008). Among the patients with rebleeding, repeated combination therapy was more effective than repeated injection therapy in achieving permanent hemostasis (100% vs 33%, P = .02). No patient required an emergency operation in the combination therapy group. However, 5 patients in the epinephrine injection group underwent emergency surgery to arrest bleeding (0% vs 9%, P = .023).
LIMITATIONS: Treatment outcome of endoscopic hemoclip therapy is related to the techniques of endoscopists.
CONCLUSION: Endoscopic combination therapy is superior to epinephrine injection alone in the treatment of high-risk bleeding ulcers.
OBJECTIVE: To compare the efficacies of epinephrine injection alone and epinephrine injection combined with hemoclip therapy in treating high-risk bleeding ulcers.
DESIGN: Prospective randomized controlled trial.
SETTING: A medical center in Taiwan.
PATIENTS: One hundred five bleeding ulcer patients with active spurting, oozing, nonbleeding visible vessels or adherent clots in ulcer bases.
INTERVENTIONS: Endoscopic combination therapy (n = 52) or diluted epinephrine injection alone (n = 53).
MAIN OUTCOME MEASUREMENTS: Initial hemostasis rates and recurrent bleeding rates.
RESULTS: Initial hemostasis was achieved in 51 patients treated with combination therapy and 49 patients with epinephrine injection therapy (98% vs 92%, P = .18). Bleeding recurred in 2 patients in the combination therapy group and 11 patients in the epinephrine injection group (3.8% vs 21%, P = .008). Among the patients with rebleeding, repeated combination therapy was more effective than repeated injection therapy in achieving permanent hemostasis (100% vs 33%, P = .02). No patient required an emergency operation in the combination therapy group. However, 5 patients in the epinephrine injection group underwent emergency surgery to arrest bleeding (0% vs 9%, P = .023).
LIMITATIONS: Treatment outcome of endoscopic hemoclip therapy is related to the techniques of endoscopists.
CONCLUSION: Endoscopic combination therapy is superior to epinephrine injection alone in the treatment of high-risk bleeding ulcers.