It is not known if combination therapy of epinephrine injection and multipolar electrocoagulation or hemoclips are a more efficient or effective treatment in acute nonvariceal upper gastrointestinal bleeding.
Dr John Saltzman and colleagues from Massachusetts studied 47 adult patients with active nonvariceal upper gastrointestinal bleeding.
The investigators included patients with a nonbleeding visible vessel, or after removal of an adherent clot findings of active bleeding or a visible vessel.
|Rebleeding occurred in 15% of hemoclip patients vs 24% in combination therapy patients|
|American Journal of Gastroenterology|
Patients were randomized to either therapy and the outcomes were assessed at 30 days.
The investigative team reported that 26 patients were randomized to hemoclips and 21 to combination therapy.
The team found that there were 22 patients with active bleeding, 13 with a nonbleeding visible vessel, and 12 with an adherent clot.
The median duration of endoscopic therapy was 17 min in the hemoclip group versus 20 min for the combination therapy.
The investigators observed that primary hemostasis with successful initial control of bleeding occurred in all 26 hemoclip patients.
For combination therapy patients, primary hemostasis with successful initial control of bleeding occurred in 20 of 21.
The investigators noted that rebleeding rates were 15% in hemoclip patients versus 24% in combination therapy patients.
Overall, the team found that the length of hospital stay, units of blood transfused, surgery rates, and mortality were not different.
Dr Saltzman's team concludes, “In this prospective, randomized controlled trial of endoscopic hemoclips versus combination therapy in the nonvariceal upper gastrointestinal bleeding, the efficiency, efficacy, and complications of the two treatment modalities were not significantly different.”