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Comparation of endoscopic dual versus monotherapy in patients with high-risk bleeding ulcers: a retrospective trial

Year 2011, Volume: 33 Issue: 2, 172 - 178, 20.06.2011

Yaşar Tuna Erhan Alkan

Abstract

Abstract

Aim. Peptic ulcer bleeding is a common medical emergency and a potentially life-threatening event. Endoscopic treatment reduces the morbidity and mortality associated with peptic ulcer bleeding. The aim of this study to compare the efficacy of dual endoscopic therapies versus endoscopic monotherapy in reducing rate of recurrent bleeding, need for surgery, and death in patients with active peptic ulcer bleeding. Method. Data of 125 patients who applied to Akdeniz University Hospital with active bleeding, or high-risk ulcers detected by endoscopy were retrospectively investigated. Epinephrine alone injection was applied to 43 patients and epinephrine plus heater probe treatment were applied to 33 patients. Gold probe and epinephrine injection combination were applied to 29 patients and only heater probe treatment was applied to 20 patients. Results. Initial endoscopic haemostasis was achived in 39/43 patients (81.7%) who received epinephrine injection alone, 33/33 patients (100%) who received additional heater probe treatment, 28/29 patients (86.4%) who received additional gold probe treatment, and 19/20 patients (95%) who received heater probe treatment alone. Treatment outcome was determined in the four treatment groups by clinical rebleeding ratios during the hospital stay. Clinical rebleeding was observed in 6 patients (15.4%) in the epinephrine alone group, in 2 patients (6.1%) in additional heater probe treatment group, in 3 patients (10.7%) in additional gold probe group, and in 2 patients (10.5%) in heater probe treatment alone group. We did not find a significant difference between these four groups by means of clinical rebleeding ratios. There was not a significant significantly different in four groups. Requirement for emergency operation was observed in 6 patients, and mean blood transfusion was 3.2±2.88 units, and mean hospital stay was 5.18±2.88 days. Conclusion. Addition of heater probe and gold probe treatment after endoscopic adrenaline injection could have an advantage in bleeding and high-risk ulcers. Lack of statistical difference between the groups could be due to the low number of patients.

Keywords: Endoscopic therapy, ulcer bleeding

 

Özet

Giriş. Peptik ülser kanamaları potansiyel olarak hayatı tehdit eden ve sık kaşılaşılan bir tıbbi acil durumdur. Endoskopik tedaviler peptik ülser kanamasına bağlı morbidite ve mortaliteyi azaltır. Bu çalışmada çiftli ve tekli endoskopik tedavilerin, aktif kanayan ülserli hastalarda, kanama tekrarı, cerrahi gereklilik ve kanamaya bağlı ölüm üzerine tedavi etkinliğinin karşılaştırılması amaçlanmıştır. Yöntem. Akdeniz Üniversitesi Hastanesi Endoskopi Ünitesine başvuran, endoskopilerinde aktif kanama veya yüksek riskli ülsere sahip 125 hastanın verileri retrospektif olarak değerlendirildi. 43 hastaya yalnızca epinefrin enjeksiyon tedavisi ve 33 hastaya epinefrin ve heater probe tedavisi uygulandı. 29 hastaya gold probe ve epinefrin enjeksiyon tedavisi ve 20 hastaya sadece heater probe tedavisi uygulandı. Bulgular. Tedavi gruplarında başlangıç hemostaz oranları, sadece epinephrine enjeksiyonunda 39/43 (%81,7), epinefrin heater probe kombinasyonunda 33/33 hasta da (%100), epinefrin enjeksiyonu ve gold probe kombinasyonunda 28/29 hastada (%86,4), ve sadece heater probe tedavisinde 19/20 hastada (%95) gerçekleşti. Tedavi sonucu olarak, hastanede yatılan süre içerisinde tekrar kanama, sadece epinefrin enjeksiyonunda 6 hastada (%15,4), epinefrin ve heater probe kombinasyonunda 2 hastada (%6,1), epinefrin enjeksiyonu ve gold probe kombinasyonunda 3 hastada (%10,7), ve sadece heater probe tedavisinde 2 hastada (%10,5) gözlenmiş olup; dört grubun arasında istatistiksel olarak anlamlı bir farklılık yoktu. 6 hastada kanama durdurulamadı ve cerrahi operasyona verildi. Hastaların ortalama yatış süreleri 5,18±2,88 gün ve ortalama transfüzyon sayıları 3,2±2,88 ünite olarak bulundu. Sonuç. Yüksek riskli veya kanamakta olan ülserlerde, endoskopik adrenalin enjeksiyonunu takiben heater veya gold probe tedavisinin eklenmesinin yalnızca epinefrin enjeksiyon tedavisine göre daha avantajlı olabileceği gözlemlendi. Çalışmadaki hasta sayısının düşük olması nedeniyle gruplar arasında istatistiksel olarak anlamlı bir fark saptanamadı.

Anahtar sözcükler: Endoskopik tedavi, ülser kanaması

Keywords

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References

  • Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal hemorrhage. Gut 1996; 38: 316-21.
  • Swain CP, Kirkham JS, Salmon PR, Bown SG, Northfield TC. Controlled trial of Nd­YAG laser photocoagulation in bleeding peptic ulcers. Lancet 1986; 1: 1113­7.
  • O'Brien JD, Day SJ, Burnham WR. Controlled trial of small bipolar probe in bleeding peptic ulcers. Lancet 1986; 1: 464­7.
  • Krejs GJ, Little KH, Westergaard H, Hamilton JK, Spady DK, Polter DE. Laser photocoagulation for the treatment of acute peptic ulcer bleeding: a randomized controlled clinical trial. N Engl J Med 1987; 316: 1618­21.
  • Leung JW, Chung SC. Endoscopic injection of adrenaline in bleeding peptic ulcers. Gastrointest Endosc 1987; 33: 73­5.
  • Panés J, Viver J, Forné M, Garcia­Olivares E, Marco C, Garau J. Controlled trial of endoscopic sclerosis in bleeding peptic ulcers. Lancet 1987; 2: 1292­4.
  • Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage: a prospective controlled trial. N Engl J Med 1987; 316: 1613­7.
  • Chung SC, Leung JW, Steele RJ, Crofts TJ, Li AK. Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial. Br Med J 1988; 296: 1631­3.
  • Balanzó J, Sainz S, Such J, Espinós JC, Guarner C, Cussó X, Monés J, Vilardell F. Endoscopic hemostasis by local injection of epinephrine and polidocanol in bleeding ulcer: a prospective randomized trial. Endoscopy 1988; 20: 289­91.
  • Steele RJ, Park KG, Croft TJ. Adrenaline injection for endoscopic haemostasis in non­variceal upper gastrointestinal haemorrhage. Br J Surg 1991; 78: 477­9.
  • Fullarton GM, Birnie GG, Macdonald A, Murray WR. Controlled trial of heater probe treatment in bleeding peptic ulcers. Br J Surg 1989; 76: 541­4.
  • Barkun A, Bardou M, Marshall JK, Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003; 139: 843-57.
  • Calvet X, Vergara M, Brullet E, Gisbert JP, Campo R. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high- risk bleeding ulcers. Gastroenterology 2004; 126: 441-50.
  • Lau JY, Chung SC, Leung JW, Lo KK, Yung MY, Li AK. The evolution of stigmata of hemorrhage in bleeding peptic ulcers: a sequential endoscopic study. Endoscopy 1998; 30: 513-18.
  • Department of Health. The health of the nation: a strategy for health in England. London: HMSO, 1992.
  • Department of Health. Obesity: Reversing the increasing problem of obesity in England. A report from the Nutrition and Physical Activity Task Forces. London: HMSO, 1995.
  • Rollhauser C, Fleischer DE. Nonvariceal upper gastrointestinal bleeding: an update. Endoscopy 1997; 29: 91-105.
  • Sacks HS, Chalmers TC, Blum AL, Berrier J, Pagano D. Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. JAMA 1990; 264: 494-9.
  • Hsu PI, Lin XZ, Chan SH, Lin CY, Chang TT, Shin JS, Hsu LY, Yang CC, Chen KW. Bleeding peptic ulcer-risk factors for rebleeding and sequential change in endoscopic findings. Gut 1994; 35: 746-9.
  • Brullet E, Campo R, Calvet X, Coroleu D, Rivero E, Simó Deu J. Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer. Gut 1996; 39: 155-8.
  • Hepworth CC, Kadirkamanathan SS, Gong F, Swain CP. A randomized controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels. Gut 1998; 42: 462-9.
  • Swain CP, Kalabakas A (1991) A randomized controlled comparison of injection of epinephrine, polidocanol, alcohol, hypertonic saline, normal saline and bipolar electrocoagulation in treatment of standard experimental bleeding ulcers and bleeding mesenteric vessels [Abstract]. Gastroenterology 100: A170.
  • Chou YC, Hsu PI, Lai KH, Lo CC, Chan HH, Lin CP, Chen WC, Shie CB, Wang EM, Chou NH, Chen W, Lo GH. A prospective, randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers. Gastrointest Endosc 2003; 57: 324-8.
  • Chung SS, Lau JY, Sung JJ, Chan AC, Lai CW, Ng EK, Chan FK, Yung MY, Li AK. Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. BMJ 1997; 314: 1307-11.
  • Saeed ZA. Second thoughts about second-look endoscopy for ulcer bleeding? Endoscopy 1998; 30: 650-2.
  • Lau JY, Sung JJ, Lam YH, Chan AC, Ng EK, Lee DW, Chan FK, Suen RC, Chung SC. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med 1999; 340: 751-6.

Comparation of two Dual Endoscopic Versus Monotherapy in Patients with High-Risk Bleeding Ulcers: A Retrospective Trial

Year 2011, Volume: 33 Issue: 2, 172 - 178, 20.06.2011

Yaşar Tuna Erhan Alkan

Abstract

Abstract

Introduction: Peptic ulcer bleeding is a common medical emergency and potentially life-threatening event. Endoscopic  treatment reduces the morbidity and mortality associated with peptic ulcer bleeding. The aim of this study to compare the efficacy of dual endoscopic therapies   versus endoscopic monotherapy  in reducing rate of recurrent bleeding, need for surgery, and death in patients with actively peptic ulcer bleeding.

Design: Retrospective study of patients admitted with actively bleeding and high-risk ulcer to endoscopic unit of Akdeniz Univercity Hospital.

Subjects: 125 patients with actively bleeding, or high-risk ulcers detected by endoscopy. Epinephrine alone injection was applied to 43 patients and epinephrine plus heater probe treatment were applied to 33 patients. Gold probe and epinephrine injection combination were applied to 29 patients and only heater probe treatment was applied to 20 patients.

Results: Initial endoscopic haemostasis was achived in 39/43 patients (81.7%) who received epinephrine injection alone,   33/33 patients (100%) who received additional heat probe treatment, 28/29 patients (86.4%) who received additional gold probe treatment, and 19/20 patients (95%) who received heater probe treatment alone. Outcome as measured by clinical rebleeding in  6 patients (15.4%) in      epinephrine alone group, 2 patients (6.1%) in additional heat probe treatment group, 3 patients (10.7%) inadditional  gold probe group, and 2 patients (10.5%) in heater probe treatment alone group were not significantly different in four groups. Requirement for emergency operation   in 6 patients, and mean blood transfution was  3.2 ± 2.88 unit, and mean hospital stay was 5.18 ± 2.88 days.

Conclution: Addition of heat probe and gold probe treatment  after endoscopic adrenaline injection has an advantage in bleeding and high-risk ulcers.

Key Wolds: Endoscopic therapy, ulcer bleeding,

 

 

Keywords

Endoskopik tedavi ülser kanaması

References

  • Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal hemorrhage. Gut 1996; 38: 316-21.
  • Swain CP, Kirkham JS, Salmon PR, Bown SG, Northfield TC. Controlled trial of Nd­YAG laser photocoagulation in bleeding peptic ulcers. Lancet 1986; 1: 1113­7.
  • O'Brien JD, Day SJ, Burnham WR. Controlled trial of small bipolar probe in bleeding peptic ulcers. Lancet 1986; 1: 464­7.
  • Krejs GJ, Little KH, Westergaard H, Hamilton JK, Spady DK, Polter DE. Laser photocoagulation for the treatment of acute peptic ulcer bleeding: a randomized controlled clinical trial. N Engl J Med 1987; 316: 1618­21.
  • Leung JW, Chung SC. Endoscopic injection of adrenaline in bleeding peptic ulcers. Gastrointest Endosc 1987; 33: 73­5.
  • Panés J, Viver J, Forné M, Garcia­Olivares E, Marco C, Garau J. Controlled trial of endoscopic sclerosis in bleeding peptic ulcers. Lancet 1987; 2: 1292­4.
  • Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage: a prospective controlled trial. N Engl J Med 1987; 316: 1613­7.
  • Chung SC, Leung JW, Steele RJ, Crofts TJ, Li AK. Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial. Br Med J 1988; 296: 1631­3.
  • Balanzó J, Sainz S, Such J, Espinós JC, Guarner C, Cussó X, Monés J, Vilardell F. Endoscopic hemostasis by local injection of epinephrine and polidocanol in bleeding ulcer: a prospective randomized trial. Endoscopy 1988; 20: 289­91.
  • Steele RJ, Park KG, Croft TJ. Adrenaline injection for endoscopic haemostasis in non­variceal upper gastrointestinal haemorrhage. Br J Surg 1991; 78: 477­9.
  • Fullarton GM, Birnie GG, Macdonald A, Murray WR. Controlled trial of heater probe treatment in bleeding peptic ulcers. Br J Surg 1989; 76: 541­4.
  • Barkun A, Bardou M, Marshall JK, Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003; 139: 843-57.
  • Calvet X, Vergara M, Brullet E, Gisbert JP, Campo R. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high- risk bleeding ulcers. Gastroenterology 2004; 126: 441-50.
  • Lau JY, Chung SC, Leung JW, Lo KK, Yung MY, Li AK. The evolution of stigmata of hemorrhage in bleeding peptic ulcers: a sequential endoscopic study. Endoscopy 1998; 30: 513-18.
  • Department of Health. The health of the nation: a strategy for health in England. London: HMSO, 1992.
  • Department of Health. Obesity: Reversing the increasing problem of obesity in England. A report from the Nutrition and Physical Activity Task Forces. London: HMSO, 1995.
  • Rollhauser C, Fleischer DE. Nonvariceal upper gastrointestinal bleeding: an update. Endoscopy 1997; 29: 91-105.
  • Sacks HS, Chalmers TC, Blum AL, Berrier J, Pagano D. Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. JAMA 1990; 264: 494-9.
  • Hsu PI, Lin XZ, Chan SH, Lin CY, Chang TT, Shin JS, Hsu LY, Yang CC, Chen KW. Bleeding peptic ulcer-risk factors for rebleeding and sequential change in endoscopic findings. Gut 1994; 35: 746-9.
  • Brullet E, Campo R, Calvet X, Coroleu D, Rivero E, Simó Deu J. Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer. Gut 1996; 39: 155-8.
  • Hepworth CC, Kadirkamanathan SS, Gong F, Swain CP. A randomized controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels. Gut 1998; 42: 462-9.
  • Swain CP, Kalabakas A (1991) A randomized controlled comparison of injection of epinephrine, polidocanol, alcohol, hypertonic saline, normal saline and bipolar electrocoagulation in treatment of standard experimental bleeding ulcers and bleeding mesenteric vessels [Abstract]. Gastroenterology 100: A170.
  • Chou YC, Hsu PI, Lai KH, Lo CC, Chan HH, Lin CP, Chen WC, Shie CB, Wang EM, Chou NH, Chen W, Lo GH. A prospective, randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers. Gastrointest Endosc 2003; 57: 324-8.
  • Chung SS, Lau JY, Sung JJ, Chan AC, Lai CW, Ng EK, Chan FK, Yung MY, Li AK. Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. BMJ 1997; 314: 1307-11.
  • Saeed ZA. Second thoughts about second-look endoscopy for ulcer bleeding? Endoscopy 1998; 30: 650-2.
  • Lau JY, Sung JJ, Lam YH, Chan AC, Ng EK, Lee DW, Chan FK, Suen RC, Chung SC. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med 1999; 340: 751-6.
There are 26 citations in total.

Details

Primary Language English
Journal Section Medical Science Research Articles
Authors

Yaşar Tuna

Erhan Alkan

Publication Date June 20, 2011
Published in Issue Year 2011Volume: 33 Issue: 2

Cite

AMA Tuna Y, Alkan E. Comparation of endoscopic dual versus monotherapy in patients with high-risk bleeding ulcers: a retrospective trial. CMJ. June 2011;33(2):172-178.