A team from Los Angeles, California, evaluated the use of normal saline injection versus bipolar electrocoagulation for treatment of patients with high-risk bleeding ulcers.
Endoscopic injection of normal saline solution is reportedly an effective treatment for bleeding ulcers.
If it is as effective as standard therapy, low cost, wide availability, and lack of injury would make saline solution injection an attractive option.
Patients with clinical evidence of major bleeding from an ulcer with active bleeding or a non-bleeding visible vessel were included in the study. They were then randomly assigned to injection with normal saline solution (1-2 ml boluses; mean volume 30 ml) or bipolar electrocoagulation (20 W, 10-sec applications; mean time 100 sec).
Patients, those caring for patients, and those collecting data were blinded to therapy.
|Disadvantages of saline injection:|
- Further bleeding in higher proportion
- More blood units transfused
| Gastrointestinal Endoscopy |
Further bleeding occurred in 14 (29%) of 48 patients in the saline solution group versus 6 (12%) of 52 patients in the bipolar group.
The team found that significantly more units of blood were transfused in the saline solution group (median 2 units vs 0 units).
Hospital days (median 4 vs 3) and mortality (6% vs 2%) were not significantly different in the two groups.
Independent risk factors for further bleeding were saline solution injection, units transfused before, and ulcer size.
Dr Loren Laine, of the USC School of Medicine, Los Angeles, concluded on behalf of the group, "Local tamponade with saline solution injection is less effective than bipolar electrocoagulation for the treatment of bleeding ulcers."