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 19 February 2018

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News

Endoscopic treatment of bleeding peptic gastroduodenal ulcer

Endoscopic practice regarding dosage or administration varies even in areas with established evidence, shows the latest issue of the Scandanavian Journal of Gastroenterology.

News image

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Dr Sven Adamson and colleagues from Denmark investigated treatment practice in non-variceal upper gastrointestinal bleeding caused by gastroduodenal ulcer.

The researchers assessed how it adheres to the best evidence as documented in randomized studies and meta-analyses.

92% of departments attempted endoscopy before surgery
Scandinavian Journal of Gastroenterology

The team surveyed the literature to identify appropriate practices.

The researchers developed a structured multiple choice questionnaire.

The team mailed the questionnaires to all departments treating upper gastrointestinal bleeding.

The researchers reported that all 42 departments responded.

All departments had therapeutic gastroscopes and equipment necessary for endoscopic hemostasis, and 90% had written guidelines.

The team noted that adjuvant pharmacologic treatment included tranexamic acid in 38%.

The researchers found that proton-pump inhibitors were used by all departments, with 29% starting prior to endoscopic treatment.

The team observed that 19% of departments used continuous proton-pump inhibitor infusion, 3 of them starting with a bolus dose.

In 50% of departments, an anesthesiologist was always present regardless of whether endotracheal intubation was used or not.

The team found that 10% of departments did not treat Forrest IIa and IIb ulcers, while IIc ulcers were treated by 36%.

In 10% of departments, clots were never removed.

The researchers found that in 2 departments attempts were made to remove resistant clots by mechanic means.

The researchers found that 17% of departments used monotherapy with epinephrine.

The team observed that 59% of departments always used dual therapy, and 19% injected less than 10 ml.

In rebleeding, 92% of the departments attempted endoscopic treatment before surgery, and used epinephrine in 79% of cases.

The team noted that the remainder of departments used epinephrine or polidocanol at the discretion of the endoscopist.

The team found that 2 out of 3 departments used high-dependency or intensive-care units for surveillance.

In addition, the researchers observed that 17% of departments applied scheduled second-look gastroscopy.

Dr Adamson's team concluded, “Practice is variable, even in areas with established evidence based on randomized controlled studies, such as dosage and way of administration and duration of proton-pump inhibitor treatment.”

“Injection treatment used as monotherapy and the volume used, including ulcers with clots for treatment, and the use of scheduled second-look endoscopy.”

“Since the rebleeding rate has remained unchanged for decades, and rebleeding implies increased surgery and mortality rates, appropriate practices must be promoted in order to improve results.”

“Development and implementation of national guidelines may facilitate the process.”

Scand J Gastroenterol 2007: 42(3): 318-23
06 March 2007

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