Endoscopic injection therapy vs. multipolar electrocoagulation vs. laser vs. injection + octreotide vs. injection + omeprazole in the treatment of bleeding peptic ulcers. A prospective randomized study.

Background/Aims: A prospective randomized study was performed to assess the effectiveness and safety of 5 different methods of bemostasis in selected patients with lugh-risk bleeding peptic ulcers. Methodology: Two hundred and etght patients (n=208: mean age:61.6 yrs) with endoscopic stigmata of active bemorrhage, non-bleeding vessei or sdherent fresb clot were randomized during emergency endoscopy to receive one of the following modalines of endoscopic therapy (with or without pharmacological therapy injection of sbsolute alcoho) (n=41:11) multipoier electrocoagulation (BICAP; n=42); III Nd-YAG laset (n=40); IV) injection of absoiute ethanol + octzeotide (n=42); V) injection of absotute ethanol+omeprazole (n=40). Results: The 5 traatment groups were clinicaliy and endoscopically comparable The initial hemostatic success was > 90% in every group. No significant differences between groups were found in any of the following parameters assessed during hospitalization: incidence of rebleeding (I=14.8% vs. II=19.0% vs III=16.6% vs IV=18.1% vs. V=20.0%: P>0.05 mean=17.7%; incidence of definitive hemostasis (I=89.3% vs. II=85.7% vs. III=86.6% vs. IV=84.0% vs. V=86.6%: P>0.05; mean=86.5%); incidence of emergency surgery (I=8.5% vs. II=11.9% vs. (11=10.0% vs. IV=6.8% vs. V=11.1%; P>0.05; mean=9.6%); mortality rate (I=4.2% vs. II=4.7% vs. III=3.3% vs. IV=13.6% vs. V=4.4%; P>0.05; mean=6.2%). Mean age of deceassed patients was significantly higher than living patients (71.2±13.4 vs. 60.9±14.4; P<0.05). Approximately 2/3 of the fatal cases were strongly weakened by coexistent medical diseases. The duration of hospital stay was 1 similar for all groups. The BICAP x group required less units of blood transfusion (1.9±1.8 vs. I=3.0±2.6; III=3.5±3.6; IV=2.8±2.3; V=3.1±2.5; P<0.05), perhaps due to the higher mean value of hemoglobin of these patients at hospitai admission, compared to all other groups. No significant complications were reported. Conclusions: This study provides good evidence that injection of absolute ethanol, multipolar electrocoaguiation (BICAP) and Nd-YAG laser are equaily safe and effective in the endoscopic therapy oi acute bleeding peptic uicers. In contrast, no additional hemostatic benefits arose from the association of pharmacological agents (octreotide or omeprazoie) to sclerosis injection.