Rebleeding occurs in 10% to 30% of bleeding ulcer patients receiving endoscopic epinephrine injection therapy.
It remains unclear whether addition of a secondary clip therapy after epinephrine injection may reduce the rebleeding rate of high-risk bleeding ulcers.
Dr Ching-Chu Lo and colleagues from Taiwan compared the efficacy of epinephrine injection alone, and with hemoclip therapy in high-risk bleeding ulcers.
The research team conducted a prospective randomized controlled trial in105 bleeding ulcer patients.
The patients had active spurting, nonbleeding visible vessels or adherent clots in ulcer bases.
The team randomized 52 patients to endoscopic combination therapy, and 53 to diluted epinephrine injection alone.
|Bleeding recurred in 4% with combination therapy vs 21% with epinephrine injection alone|
The researchers achieved initial hemostasis in 98% of patients treated with combination therapy vs 92% of patients with epinephrine injection therapy.
Bleeding recurred in 4% of patients in the combination therapy group, and in 21% of patients in the epinephrine injection group.
Among the patients with rebleeding, repeated combination therapy achieved permanent hemostasis in all patients vs only 33% with repeated injection therapy.
The team observed that no patient required an emergency operation in the combination therapy group.
However, the researchers noted that 9% of patients in the epinephrine injection group underwent emergency surgery to arrest bleeding.
Dr Lo's team concluded, “Treatment outcome of endoscopic hemoclip therapy is related to the techniques of endoscopists.”
“Endoscopic combination therapy is superior to epinephrine injection alone in the treatment of high-risk bleeding ulcers.”