Endoscopic Injection of Absolute Ethanol Achieves Ultimate Hemostasis in Bleeding Caused by Peptic Ulcers
ABSTRACT This study was performed to assess the efficacy of endoscopic injection therapy with absolute ethanol to prevent emergency surgery and recurrent bleeding in patients with peptic ulcers. We compared two different treatment protocols of peptic ulcers with active bleeding or with visible vessels on the ulcer bed. In group I (1981–1984, control group), 45 patients underwent emergency endoscopy with spraying 0.1% epinephrine and thrombin, but no other endoscopic hemostatic procedure. In group II (1989–1992, experimental group), we performed endoscopic injection therapy with absolute ethanol for peptic ulcers in 46 patients. The background characteristics of the patients were not different in the two groups. The rate of successful initial hemostasis tended to be greater in the ethanol injection group compared with the control group without significance. The ultimate hemostatic rate in the ethanol injection group was markedly and significantly greater compared to the control group (P<0.05). Ultimate hemostasis by ethanol injection was performed effectively in peptic ulcers with spurting and oozing hemorrhage and in the non-bleeding peptic ulcers with visible vessels at the initial endoscopy (P<0.05 for each). These results indicate that ethanol injection therapy by endoscopy achieves ultimate hemostasis and prevents emergency surgery due to hemorrhage from peptic ulcers. (Dig Endoc 1994; 6 : 34–38)
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ABSTRACT: A prospective randomised trial was performed to assess the efficacy of endoscopic injection of adrenaline for actively bleeding ulcers. Emergency endoscopy in 961 patients admitted for upper gastrointestinal haemorrhage identified 68 patients with actively bleeding ulcers. These 68 patients were randomised to receive either endoscopic injection of adrenaline or no endoscopic treatment. After endoscopy both groups were managed in an identical manner, and strict criteria for emergency operation were adhered to in both groups. Bleeding was initially controlled in all 34 patients assigned to the treatment group. Significantly fewer patients in the treatment group than in the control group needed emergency operations (five v 14, respectively). In addition, in the treatment group the median transfusion requirement was significantly less (three v five units of blood) and the median hospital stay shorter (six v eight days). No complications were observed with the injection of adrenaline, and the rate of healing of ulcers in those attending for endoscopy six weeks after discharge was similar in both groups (81% (17 out of 21 patients) in the treatment group v 79% (11 out of 14) in the control group). Injection of adrenaline is effective in stopping bleeding from actively bleeding ulcers.British medical journal (Clinical research ed.) 07/1988; 296(6637):1631-3.
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ABSTRACT: Eighty patients with peptic ulcers (45 duodenal ulcers, 30 gastric ulcers, and 5 stomal ulcers) presented at our emergency endoscopy unit with acute upper gastrointestinal haemorrhage (Forrest Ia, spurting bleeding; Forrest Ib, oozing bleeding) or stigmata of recent bleeding (Forrest II). They were divided into two groups, A and B, according to the day of the week on which emergency endoscopy was performed. Group A, consisting of 39 patients (24 duodenal ulcers, 13 gastric ulcers, and 2 stomal ulcers) was submitted to conventional treatment (blood transfusions, antacids, cimetidine, pirenzepine). Group B consisted of 41 patients (21 duodenal ulcers, 17 gastric ulcers and 3 stomal ulcers) on whom endoscopic haemostatic injection with absolute alcohol (Asaki's method) was performed. Patients of both groups underwent emergency surgery if the haemorrhage did not stop or if it recurred. In 10 cases (4 in group A and 6 in group B), elective surgery was performed, i.e. several days after the bleeding episode under conditions of haemodynamic safety. Endoscopic injection of absolute alcohol succeeded in arresting the haemorrhage in 17 of the 18 Forrest Ia and Ib cases and prevented recurrence in all Forrest II cases. Significant differences were recorded between the two groups as regards the number of patients undergoing surgery (18 to 7), emergency surgery (14 to 1) and the mortality (15% compared to 2.4%). The greatest difference was recorded between the postoperative mortality (27% in group A and 0% in group B).(ABSTRACT TRUNCATED AT 250 WORDS)Surgical Endoscopy 02/1988; 2(4):237-9. · 3.43 Impact Factor
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ABSTRACT: Of 113 patients in whom endoscopy revealed a bleeding gastric or duodenal ulcer 55 were randomly allocated to receive endoscopic sclerosis (ES) (injections of adrenaline/polidocanol) plus cimetidine while 58 received cimetidine alone as controls. 3 patients treated with ES (5.5%) compared with 25 controls (43.1%) had a major recurrent haemorrhage during their hospital stay. ES also led to significant reductions in the need for emergency surgery (3 vs 20 patients), transfusion requirements (mean 0.42 [SD 1.1] vs 2.7 (3.19) U), and the length of hospital stay (11.6 [5.1] vs 16.2 [11.3] days). ES as an adjunct to conventional medical treatment is an effective and safe emergency therapy for gastrointestinal bleeding due to peptic ulcer.The Lancet 01/1988; 2(8571):1292-4. · 39.06 Impact Factor