A prospective, randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers

Chou, Yuh-Chyi; Hsu, Ping‐I; Lai, Kwok‐Hung; Lo, Ching‐Chu; Chan, Hoi‐Hung; Lin, Chi‐Pin; Chen, Wen‐Chi; Shie, Chang‐Bih; Wang, E.-Ming; Chou, Nan‐Hua; Chen, Wency; Lo, Gin‐Ho

doi:10.1067/mge.2003.103

Cited by 67 publications

(34 citation statements)

References 23 publications

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“…As a mechanical method of hemostasis, the hemoclip application was first introduced in 1975 [18,19] . Due to its simplicity, low cost, easy availability, repetition, minimal damage to the localized field, and reduced risk of adverse effects, hemoclips have been widely used for the treatment of nonvariceal bleeding in the upper GI tract, such as bleeding peptic ulcer [20,21] , Dieulafoy's lesion bleeding [22,23] (Figures 1 and 2), Mallory-Weiss syndrome [24,25] (Figure 3), post-polypectomy bleeding [26] , and post-sphincterotomy bleeding [27] . It is suggested that …”

Section: Discussionmentioning

confidence: 99%

Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

Guo¹,

Gong²,

Leng³

et al. 2009

WJG

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AIM:To investigate acute nonvariceal bleeding in the upper gastrointestinal (GI) tract and evaluate the effects of endoscopic hemoclipping. METHODS:Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS:The 68 cases (male:female = 42:26, age from 9 to 70 years, average 54.4) presented with hematemesis in 26 cases (38.2%), melena in nine cases (13.3%), and both in 33 cases (48.5%). The causes of the bleeding included gastric ulcer (29 cases), duodenal ulcer (11 cases), Dieulafoy's lesion (11 cases), Mallory-Weiss syndrome (six cases), postoperative (three cases), post-polypectomy bleeding (five cases), and post-sphincterotomy bleeding (three cases); 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery (three cases had peptic ulcers, one had Dieulafoy's lesion, and two were caused by sphincterotomy); three patients died (two had Dieulafoy's lesion and one was caused by sphincterotomy); and one had recurrent bleeding with Dieulafoy's lesion 10 mo later, but in a different location. CONCLUSION:Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.

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Section: Discussionmentioning

confidence: 99%

Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

Guo¹,

Gong²,

Leng³

et al. 2009

WJG

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“…Endoclips are deployed on a visible vessel to achieve vascular compression and can achieve homeostasis in up to 100% of cases. 46 Comparative studies suggest lower re-bleeding rates than adrenaline injection, 47 ethanol 48 or saline/ adrenaline injection. 49 The additional benefit of adrenaline with a mechanical method is unclear, 50 although one randomised comparative study of combination epinephrine-polidocanol injection and Hemoclip versus Hemoclip alone for bleeding peptic ulcers showed clipping to be inferior to combination therapy.…”

Section: Endoscopic Managementmentioning

confidence: 99%

Nonvariceal Upper Gastrointestinal Bleeding

Ferguson

Mitchell²

2004

Endoscopy

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A study in the Netherlands examined recent time trends in the incidence and outcome of upper gastrointestinal bleeding between the periods 1993-94 and 2000 [1]. The incidence of acute upper gastrointestinal bleeding decreased from 61.7 per 100 000 in 1993-94 to 47.7 per 100 000 persons annually in 2000, corresponding to a 23 % decrease in the incidence after age adjustment (95 % CI, 15 % to 30 %). Despite more frequent use of combination treatment, more frequent endoscopic interventions to treat ulcers with adherent clots, and a higher rate of protonpump inhibitor (PPI) use in the second period, the rebleeding rate (16 % vs. 15 %) and mortality rate (14 % vs. 13 %) did not differ between the two periods. Ulcer bleeding remained the most frequent cause of bleeding, at 40 % (1993-94) and 46 % (2000). Almost half of all patients with peptic ulcer bleeding were using nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin. Re-bleeding was similarly high among patients with peptic ulcer bleeding in both groups (20 % and 22 %, respectively). Increasing age, presence of severe comorbidities, and rebleeding were associated with higher mortality. An analysis of secular trends in hospitalization and mortality rates from peptic ulcer disease, upper gastrointestinal bleeding, and any gastrointestinal bleeding was published using data from the National Hospital Discharge Survey [2]. These rates were compared with sales of NSAIDs, aspirin, and acid-suppression medications from 1992 to 1999. Annual rates of hospitalization and mortality per 100 000 population for peptic ulcer disease declined from 205 to 165 and 7.7 to 6.0, respectively; the calendar year correlated negatively with both peptic ulcer disease hospitalization rates (P = 0.007) and mortality rates (P = 0.058). Sales of acid-suppression medications correlated negatively with peptic ulcer disease hospitalization rates (P = 0.037) and mortal

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“…Insgesamt besteht klinische und experimentelle Erfahrung mit dem Einsatz von Clips in der endoskopischen Blutstillungstherapie seit mehr als 25 Jahren. In prospektiv randomisierten Studien konnte in den letzten 10 Jahren die Effektivität des Hämoclips allein oder in Kombination mit anderen Verfahren (Injektion) in der Therapie von Ulkusblutungen bewiesen werden [5][6][7][8][9]. In allen Studien schnitt die alleinige Clip-Therapie oder die Kombination von Clip-Therapie und Injektionstherapie gleich gut oder besser als die alleinige Injektionstherapie ab, welche als preisgünsti-ges, überall verfügbares Verfahren immer noch als Therapie der Wahl bei Ulkusblutungen gilt [5][6][7][8][9].…”

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“…In prospektiv randomisierten Studien konnte in den letzten 10 Jahren die Effektivität des Hämoclips allein oder in Kombination mit anderen Verfahren (Injektion) in der Therapie von Ulkusblutungen bewiesen werden [5][6][7][8][9]. In allen Studien schnitt die alleinige Clip-Therapie oder die Kombination von Clip-Therapie und Injektionstherapie gleich gut oder besser als die alleinige Injektionstherapie ab, welche als preisgünsti-ges, überall verfügbares Verfahren immer noch als Therapie der Wahl bei Ulkusblutungen gilt [5][6][7][8][9]. Insgesamt zeigen die Ergebnisse verschiedener prospektiver Studien, dass die Kombination aus Injektions-und Clip-Therapie oder Injektionstherapie und thermischen Verfahren einer alleinigen Therapie mit einem dieser Blutstillungsverfahren überlegen ist [5,7,10].…”

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