Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding

Department of Internal Medicine, 'Sestre milosrdnice' University Hospital Center, 10000 Zagreb, Croatia.
World Journal of Gastroenterology (Impact Factor: 2.37). 05/2012; 18(18):2219-24. DOI: 10.3748/wjg.v18.i18.2219
Source: PubMed


To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.
Between January 2005 and December 2009, 150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed (Forrest IIa) were included in the study. Patients were randomized to receive a small-volume epinephrine group (15 to 25 mL injection group; Group 1, n = 50), a large-volume epinephrine group (30 to 40 mL injection group; Group 2, n = 50) and a hemoclip group (Group 3, n = 50). The rate of recurrent bleeding, as the primary outcome, was compared between the groups of patients included in the study. Secondary outcomes compared between the groups were primary hemostasis rate, permanent hemostasis, need for emergency surgery, 30 d mortality, bleeding-related deaths, length of hospital stay and transfusion requirements.
Initial hemostasis was obtained in all patients. The rate of early recurrent bleeding was 30% (15/50) in the small-volume epinephrine group (Group 1) and 16% (8/50) in the large-volume epinephrine group (Group 2) (P = 0.09). The rate of recurrent bleeding was 4% (2/50) in the hemoclip group (Group 3); the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution (P = 0.0005 and P = 0.045, respectively). Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups.
Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.

Download full-text


Available from: Tajana Pavić
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bleeding is a common occurrence in practice, but occasionally it may be challenging issue to overcome. It can come from numerous sources such as, trauma, during or post-surgical intervention, disorders of platelet and coagulation factors and increased fibrinolysis, wounds and cancers. This paper was inspired from our experience with a patient admitted to a local long term acute care facility with a large fungating right breast cancerous wound. During her hospital stay spontaneous bleeding from her breast cancerous mass was encountered and became more frequent and significant over the period of her stay. Different hemostatic technologies were used to control her bleeding. We felt that it was important to share our experience with our colleagues to help with potential similar situation that they may face.
    No preview · Article · Jun 2012 · Journal of the American College of Clinical Wound Specialists
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Non-variceal upper gastrointestinal bleeding is a common emergency associated with significant morbidity and mortality. The mainstays of therapy include prompt resuscitation, early risk stratification, and appropriate access to endoscopy. Patients with high-risk endoscopic findings should receive endoscopic hemostasis with a modality of established efficacy. The pillar of post-endoscopic therapy is acid-suppression via proton pump inhibitors (PPI), although the optimal dose and route of administration are still unclear. Post-discharge management of patients with peptic ulcers includes standard oral PPI treatment and eradication of Helicobacter pylori infection. The risk of recurrent bleeding should be carefully considered and appropriate gastroprotection should be offered when non-steroid anti-inflammatory drugs, anti-platelet agents, and/or anticoagulation need to be used. This review seeks to survey new evidence in the management of non-variceal upper gastrointestinal bleeding that has emerged in the past 3 years and put it into context with recommendations from recent practice guidelines.
    Full-text · Article · Mar 2013 · Annals of Gastroenterology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To develop a new hemostatic device for endoscopic surgery that can control the bleeding without completely occluding the bleeding vessel. A hemostatic clip and its applier that can stanch bleeding while maintaining blood flow through the clipped vessel was introduced, and the performance of the proposed clip was evaluated using in vitro and in vivo experiments. During in vitro experiments, no leakage was found after clipping at cuts made in artificial vessels, and flow was maintained through the clipped artificial vessels. In experiments on rats, all the implanted clips occluded the target vessels successfully, and no bleeding or tissue damage was observed at the operative site after the rats were euthanized on postoperative day 7. In experiments on pigs, bleeding stopped immediately after partial clipping of a damaged vessel, and some amount of blood flow was consistently maintained through the clipped vessel after hemostasis. We believe that the proposed hemostatic clip and clip applier can enhance patient safety during laparoscopic surgery.
    Preview · Article · Feb 2014 · World Journal of Gastroenterology
Show more