PEPTIC ULCER HEMORRHAGE: COMPARISON OF EFFICACY OF TWO METHODS OF ENDOSCOPIC HEMOSTASIS – A PROSPECTIVE STUDY
DOI:
https://doi.org/10.6016/ZdravVestn.2273Keywords:
peptic ulcer, hemorrhage, endoscopic hemostasis, argon plasma coagulation, injection sclerotherapy, prospective studyAbstract
Background. Interventional endoscopy has largely reduced mortality in patients with peptic ulcer hemorrhage.
Study aims. To evaluate the efficacy and safety of endoscopic hemostasis with argon plasma coagulation and injection sclerotherapy in bleeding peptic ulcer and determine the mortality of patients in a prospective, controlled study.
Patients and methods. The study includes 100 patients with peptic ulcer hemorrhage (male 63, female 37, av. age 57.1 years, SD ± 16, span 26–80; gastric ulcer 50 patients, duodenal ulcer 50 patients) in the period between 1 Jan. 1999 and 15 May 2000 treated in our institution. The bleeding activity was determined according to Forrest classification. Fifty patients were randomized to receive argon plasma coagulation (ARCO 2000 Electro Surgery unit, group A) and in fifty patients injection sclerotherapy (sclerosing with diluted adrenalin 1:10,000 plus polidocanol 1%, group B) was performed. The groups did not differ with respect to age, sex, site, severity of bleeding, use of NSAID and additional diseases.
Results. Clinically and endoscopically diagnosed reebleding occured in 7/50 patients (14%) in group A and in 9/50 patients (18%) in group B; p = 0.78. The majority of reebleding occured within 48 hours after endoscopic hemostasis, group A 4/7 (57.1%), group B 7/9 (77.7%), p = 0.74. Repeated endoscopic hemostasis did not prove successful in 8 patients (group A 3/50, 6%, group B 5/50, 10%), p = 0.71. Seven patients were treated operatively. The total mortality rate was 9% (9/100 patients, group A 4/50, 8%, group B 5/50, 10%), p > 0.05. Only one patient died due to peptic ulcer hemorrhage, other 8 patients died due to concomitant diseases.
Conclusions. Argon plasma coagulation seems to be an effective and safe alternative to injection sclerotherapy and other hemostatic modalities in peptic ulcer hemorrhage.
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References
Skok P. Incidenca krvavitev iz zgornje prebavne cevi – petletna prospektivna študija. Zdrav Vestn 2000; 69: 727–31.
Skok P. The epidemiology of hemorrhage from the upper gastrointestinal tract in the mid-nineties – has anything changed? Hepatogastroenterology 1998; 24: 2228–33.
Skok P. How efficient is endoscopic injection sclerotherapy in peptic ulcer hemorrhage? Hepatogastroenterology 1997; 15: 861–5.
Friedmann L, Martin P. The problem of gastrointestinal bleeding. Gastro Clin North Am 1993; 22: 717–21.
Skok P. Peptična razjeda – najpogostejši vzrok krvavitve iz prebavne cevi. Zdrav Vestn 1999; 68: 415–9.
Cook DJ, Guyatt GH, Salena BJ et al. Endoscopic therapy for acute non variceal upper gastrointestinal haemorrhage: A meta-analysis. Gastroenterology 1992; 102: 139–48.
O’Connor KW, Robinson M, Boyce G et al. The role of endoscopy in the management of non variceal acute upper gastrointestinal bleeding. Gastrointest Endosc 1992; 38: 760–4.
Steffes C, Sugawa C. Endoscopic management of non variceal gastrointestinal bleeeding. World J Sur 1992; 16: 1025–33.
Kohler BJ, Riemann F. Upper gastrointestinal bleeding value and consequences of emergency endoscopy and endoscopic treatment. Hepatogastroenterology 1994; 38: 198–200.
Gupta PK, Fleischer D. Endoscopic hemostasis in non-variceal bleeding. Endoscopy 1994; 26: 48–54.
Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC). First clinical experiences in flexible endoscopy. End Surg 1994; 2: 42–6.
Grund KE, Zindel C, Farin G. Argon plasma coagulation through a flexible endoscope. Evaluation of a new therapeutic method after 1606 uses. Dtsch Med Wochenschr 1997; 122: 432–8.
Wahab PJ, Mulder CJJ, den Hartog G, Thies JE. Argon plasma coagulation in flexible gastrointestinal endoscopy. Pilot experiences. Endoscopy 1997; 29: 176–81.
Johanns W, Luis W, Janssen J, Kahl S, Greiner L. Argon plasma coagulation (APC) in gastroenterology: experimental and clinical experiences. Eur J Gastroenterol Hepatol 1997; 9: 581–7.
Conio M, Gostout CJ. Argon plasma coagulation (APC) in gastroenterology: experimental and clinical experiences. Gastrointest Endosc 1998; 48: 109– 10.
Skok P, Pocajt M. Argon plasma coagulation in giant antral polyp, causing intermittent gastric outlet obstruction – case report. Endosk Heute 1999; 12: 20–2.
Palmer KR. Ulcers and nonvariceal bleeding. Endoscopy 2000; 32: 118–23.
Aabakken L. Nonvariceal gastrointestinal bleeding. Endoscopy 2001; 33: 16–23.
Kohler B, Riemann JF. The endoscopic Doppler: Its value in evaluating gastroduodenal ulcers after hemorrhage and as an instrument of control of endoscopic injection therapy. Scand J Gastroenterol 1991; 26: 471–6.
Hepworth CC, Kadirkamathan SS, Swain CP, Gong F. Comparison of endoscopic mechanical and injection methods of hemostasis on mesenteric vessels. Gut 1994; 36: Suppl: S35–S9.
Skok P. Endoscopic hemostasis in exulceratio simplex – Dieulafoy’s disease hemorrhage: a review of 25 cases. Endoscopy 1998; 30: 590–4.
Rockall TA, Logan RFA, Devlin HB, Northfield TC. Incidence of and mortality from upper gastrointestinal haemorrhage in the United Kingdom. BMJ 1995; 311: 226–30.
Katz J. The clinical course of peptic ulcer disease. Med Clin North Am 1991; 75: 831–40.
Kreiss C, Blum AL. Epidemiology and risk factors of gastroduodenal ulcer. Chirurg 1996; 67: 7–13.
Sonnenberg A, Everhart JE. Health impact of peptic ulcer in the United States. Am J Gastroenterol 1997; 92: 614–20.
Fock KM. Peptic ulcer disease in the 1990s: an Asian perspective. J Gastroenterol Hepatol 1997; 12: S23–8.
Segal WN, Cello JP. Hemorrhage in the upper gastrointestinal tract in the older patient. Am J Gastroenterol 1997; 92: 42–6.
Brullet E, Calvet X, Campo R, Rue M, Catot L, Donoso L. Factors predicting failure of endoscopic injection therapy in bleeding duodenal ulcer. Gastrointest Endosc 1996; 43: 111–6.
Kohler B, Maier M, Benz C, Riemann JF. Acute ulcer bleeding. A prospective randomized trial to compare Doppler and Forrest classifications in endoscopic diagnosis and therapy. Dig Dis Sci 1997; 42: 1370–4.
Imhof M, Ohmann C, Hartwig A, Thon KP, Hengels KJ, Roher HD.Which peptic ulcers bleed? Results of a case-control study. DUSUK Study Group. Scand J Gastroenterol 1997; 32: 131–8.
Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med 1994; 331: 717– 21.
Meier R, Wettstein AR. Treatment of acute nonvariceal upper gastrointestinal hemorrhage. Digestion 1999; 60: Suppl: 47–52.
Rollhauser C, Fleischer DE. Upper gastrointestinal nonvariceal bleeding: A review covering the years 1996–97. Endoscopy 1998; 30: 114–25.
Skok P, Sinkovič A, Čeranič D, Pocajt M. Peptic ulcer bleeding in Intensive Care Unit (ICU): a prospective, controlled, randomized study. Critical Care 2001; 5: Suppl 1: S 65–5.
Skok P, Križman I, Skok M. Krvaveča peptična razjeda, nesteroidna protivnetna zdravila in okužba s Helicobacter pylori – prospektivna, kontrolirana, randomizirana raziskava. Zdrav Vestn 2002; 71: 357–62.
Kovacs TO, Jensen DM. Recent advances in the endoscopic diagnosis and therapy of upper gastrointestinal, small intestinal and colonic bleeding. Med Clin North Am 2002; 86: 1319–56.
Repici A, Ferrari A, De-Angelis C. Adrenaline plus cyanoacrylate injection for treatment of bleeding peptic ulcers after failure of conventional endoscopic haemostasis. Dig Liver Dis 2002; 34: 349–55.
Rockall, Logan RFA, Devlin HB et al. Risk assessment after upper gastrointestinal hemorrhage. Gut 1996; 38: 316–22.
Vreeburg EM, Terwee CB, Snel P et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 1999; 44: 331–5.
Lee JG, Liebermann DA. Complications related to endoscopic hemostasis techniques. Gastrointest Endosc Clin N Am 1996; 6: 305–21.
Cash BD. Evidence-based medicine as it applies to acid suppression in the hospitalized patient. Crit Care Med 2002; 30: Suppl 6: S373–8.
Rollhauser C, Fleischer DE. Nonvariceal upper gastrointestinal bleeding. Endoscopy 2002; 34: 111–8.
Monig SP, Lubke T, Baldus SE, Schafer H, Holscher AH. Early elective surgery for bleeding ulcer in the posterior duodenal bulb. Own results and review of the literature. Hepatogastroenterology 2002; 49: 416–8.
Freeman ML. Training endoscopists to recognize the stigmata of hemorrhage in bleeding ulcers. Endoscopy 1995; 27: 90–2.
Lau JYW, Sung JY, Lau JFT et al. Stigmata of recent hemorrhage in peptic ulcer bleeding: is there inter-observer agreement among international experts? Digestive Disease Week, San Diego, 14–17 May 1995, Abstract No. 1703.
Mondardini A, Barletti C, Rocca G et al. Non variceal upper gastrointestinal bleeding and Forrest’s classification: Diagnostic agreement between endoscopists from the same area. Endoscopy 1998; 30: 508–12.
Swain P. Perception and interpretation: The problem of the visible vessel. Endoscopy 1998; 30: 570–4.
Villanueva C, Balanzo J, Espinos JC et al. Prediction of therapeutic failure in patients with bleeding peptic ulcer treated with endoscopic injection. Dig Dis Sci 1993; 38: 2062–70.
Zimmerman J, Siguencia J, Tsvang E et al. Predictors of mortality in patients admitted to hospital for acute upper gastrointestinal hemorrhage. Scand J Gastroenterol 1995; 30: 327–31.
Skok P. Peptic ulcer hemorrhage: Evaluation of risk factors of mortality. In: Bismuth H, Galmiche JP, Huguier M, Jaeck D eds. 8th World Congress of the International Gastro-Surgical Club; Strassburg/France; April 15–18, 1998. Bologna: Monduzzi Editore S.p.a., 1998: 97–100.
Saeed ZA, Cole RA, Ramirez FC et al. Endoscopic retreatment after sucessful initial hemostasis prevents ulcer rebleeding: A prospective randomized trial. Endoscopy 1996; 28: 288–94.
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