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

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

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,