Comparison of haemostatic efficacy for endoscopic injection therapy of epinephrine and combination therapy of epinephrine and hemoclips for bleeding peptic ulcers
2012
Introduction. Endoscopic injection therapy of epinephrine is safe and
effective in the treatment of bleeding peptic ulcer, but with high risk of
rebleeding. The combination therapy of epinephrine and hemoclips could lead
to a reduction of rebleeding and a potential reduction in mortality.
Objective. To investigate the efficacy and safety of epinephrine injection
therapy and combination therapy with epinephrine and hemoclips in treating
bleeding peptic ulcers. Methods. A prospective randomized study included 58
patients with bleeding gastric or duodenal ulcer. In 30 patients endoscopic
injection therapy with diluted epinephrine was applied (group I), while in 28
patients combination therapy of epinephrine and hemoclips was applied (group
II). Results. Initial haemostasis was achieved in most patients treated with
epinephrine injection therapy (93.3%) and patients treated with combination
therapy of epinephrine and hemoclips (96.4%). After initial haemostasis was
achieved rebleeding was significantly more frequent in the patients treated
with epinephrine (28.5%) than in the patients treated with combination
therapy (3.7%, p<0.05). Two patients treated with epinephrine injection
therapy were subjected to surgical intervention, whereas no patient treated
with combination therapy needed surgery. Lethal ending occurred in one
patient treated with epinephrine and in one patient treated with combination
therapy. The difference between the two groups of patients in need for
surgical intervention and mortality was not statistically significant.
Conclusion. Combination therapy with epinephrine and hemoclips is more
efficient than epinephrine alone in the treatment of bleeding peptic ulcers.
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