A randomized trial comparing heater probe plus thrombin with heater probe plus placebo for bleeding peptic ulcer

Church, Nicholas I.; Dallal, Helen; Masson, John; Mowat, N. A. G.; Johnston, D.; Radin, E; Turner, Marc; Fullarton, Grant; Prescott, R. J.; Palmer, K R

doi:10.1016/s0016-5085(03)00889-8

Cited by 31 publications

(8 citation statements)

References 29 publications

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“…A larger high-quality study found that injection of thrombin plus heater probe was not better than heater probe alone ( 71 ). Th us, although limited information suggests that epinephrine followed by thermal contact therapy may be more effi cacious than thermal therapy alone, data are insufficient to recommend that thermal contact devices should not be used alone as monotherapy.…”

Section: Epinephrine Therapy Should Not Be Used Alone If Used It Shmentioning

confidence: 99%

Management of Patients With Ulcer Bleeding

Laine

Jensen

2012

American Journal of Gastroenterology

650

547

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Ulcers are the most common cause of hospitalization for upper gastrointestinal bleeding (UGIB), and the vast majority of clinical trials of therapy for nonvariceal UGIB focus on ulcer disease. Th is guideline provides recommendations for the management of patients with overt UGIB due to gastric or duodenal ulcers. "Overt" indicates that patients present with symptoms of hematemesis, melena, and/or hematochezia. We fi rst discuss the initial management of UGIB in patients without known portal hypertension, including initial assessment and risk stratifi cation, pre-endoscopic use of medications and gastric lavage, and timing of endoscopy. We then focus on the endoscopic and medical management of ulcer disease, including endoscopic fi ndings and their prognostic implications, endoscopic hemostatic therapy, post-endoscopic medical therapy and disposition, and prevention of recurrent ulcer bleeding.Each section of the document presents the key recommendations related to the section topic, followed by a summary of the supporting evidence. A summary of recommendations is provided in Table 1 .A search of MEDLINE via the OVID interface using the MeSH term " gastrointestinal hemorrhage " limited to " all clinical trials " and " meta-analysis " for years 1966 -2010 without language restriction as well as review of clinical trials and reviews known to the authors were performed for preparation of this document. Th e GRADE system was used to grade the strength of recommendations and the quality of evidence ( 1 ). Th e quality of evidence, which infl uences the strength of recommendation, ranges from " high " (further research is very unlikely to change our confi dence in the estimate of eff ect) to " moderate " (further research is likely to have an important impact on our confi dence in the estimate of eff ect and may change the estimate) to " low " (further research is very likely to have an important impact on our confi dence in the estimate of eff ect and is likely to change the estimate), and " very low " (any estimate of eff ect is very uncertain). Th e strength of a recommendation is graded as strong when the desirable eff ects of an intervention clearly outweigh the undesirable eff ects and is graded as conditional when uncertainty exists about the trade-off s ( 1 ). In addition to quality of evidence and balance between desirable and undesirable eff ects, other factors aff ecting the strength of recommendation include variability in values and preferences of patients, and whether an intervention represents a wise use of resources ( 1 ). 2. Blood transfusions should target hemoglobin ≥ 7 g / dl, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or comorbidities, such as coronary artery disease (Conditional recommendation). Management of Patients With Ulcer Bleeding3. Risk assessment should be performed to stratify patients into higher and lower risk categories and may assist in initial decisions such as timing of endoscopy, time of discharge, and level of care (Cond...

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Section: Epinephrine Therapy Should Not Be Used Alone If Used It Shmentioning

confidence: 99%

Management of Patients With Ulcer Bleeding

Laine

Jensen

2012

American Journal of Gastroenterology

650

547

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“…36 A separate class of injectable agents includes thrombin, fibrin, and cyanoacrylate glues, which are used to create a primary tissue seal at a bleeding site. 37 With the exception of dilute epinephrine, injectable agents are not commonly used in the treatment of non-variceal UGIB.…”

Section: Injectionmentioning

confidence: 99%

The role of endoscopy in the management of acute non-variceal upper GI bleeding

Hwang¹,

Fisher²,

Ben–Menachem³

et al. 2012

Gastrointestinal Endoscopy

303

205

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“…Malgré l'absence d'hémostase endoscopique dans notre étude, le taux de mortalité observé dans cette étude paraît similaire ou moins élevé par rapport aux résultats des études n'ayant pas sélectionné les malades (1 à 7 %) [18,39,40]. En revanche, dans les études visant à déterminer l'efficacité de l'hémostase endoscopique chez des malades à haut risque de récidive, des taux nettement plus élevés ont été observés [4,8,16,21,24,41,42]. Ces résultats sont confirmés par des travaux ayant étudié les facteurs prédictifs de décès dans une population hypersélectionnée [4,8,16,43].…”

Section: Analyse Statistiqueunclassified

Les hémorragies digestives ulcéreuses au CHU Hassan-II de Fès: approche épidémiologique

Benajah

Aqodad

Fakir

et al. 2009

J Afr Hepato Gastroenterol

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But : Évaluer et préciser le profil épidémiologique des patients présentant des hémorragies digestives ulcé-reuses au CHU Hassan-II de Fès, afin d'améliorer leur prise en charge. Patients et méthodes : Sur une période de trois ans, tous les patients présentant une hémorragie digestive ulcéreuse ont été inclus dans cette étude. Une fiche comportant différentes variables a été élaborée, comportant différentes rubriques : la présence de comorbidités, la prise médicamenteuse, les différentes modalités thérapeutiques et enfin les taux de récidive hémorragique et de décès. Résultats : Deux cent quatre-vingt-dix fiches étaient analysables. On avait noté une nette prédominance masculine (75,86 %, p < 0.05), d'un âge moyen de 47 ± 17 ans, avec une prise d'anti-inflammatoires non stéroïdiens chez 21 patients (9,5 %). Quatre-vingt-onze pour cent des ulcères étaient de siège bulbaire. Les ulcères hémorragiques de stades Ia, Ib et IIc de Forrest étaient notés dans 15,1 % des cas. Le traitement antisécrétoire était le plus souvent de l'oméprazole à forte dose (80 mg) par voie orale. Trentequatre patients (14,5 %) avaient récidivé, 17 (7 %) avaient bénéficié d'une chirurgie d'hémostase, aucune hémostase endoscopique n'a été réalisée et 11 patients (3,7 %) sont décédés. Seuls l'âge et le stade de Forrest étaient des facteurs prédictifs de récidive. Conclusion : Les hémorragies ulcéreuses au CHU de Fès sont moins sévères que celles des pays développés et, cela, à cause d'un profil épidémiologique différent. L'âge et le stade de Forrest sont des facteurs prédictifs de récidive hémorragique.Mots clés Ulcère bulbaire hémorragique · Hémostase · Mortalité · Récidive Abstract Aim: Evaluate and refine the epidemiological profile of patients presenting bleeding peptic ulcers at the Fez Hassan-II Teaching Hospital, in order to improve their health care. Patients and methods: Over a period of three-years, all patients presenting a bleeding peptic ulcer were included in this study. An identification form was elaborated. The form includes different variables such as: presence of comorbidity, medicines taken, different therapies and rates of hemorrhagic relapse and death. Results: Two hundred ninety identification forms were analysed. Male predominance (75.86%) was noted, with an average age of 47 ± 17 years and the use of non-steroidal anti-inflammatory drugs by 21 patients (9.5%). Ninety-one percent of the ulcers were located in the bulb. Bleeding ulcers at Forrest stages Ia, Ib and II were noted in 15.1% of cases. Anti-secretory treatment was most often omeprazole, taken orally. Thirty-four patients (14.5%) had relapsed, 17 (7%) had undergone haemostatic surgery, and no patient was treated by endoscopic hemostasia. Eleven patients (3.7%) died. Only age and Forrest stages were the factors predicting relapse. Conclusion: Cases of bleeding peptic ulcers at the Fez Hassan-II Teaching Hospital were less severe than in developed nations and this is because of a different epidemiological profile. Age and Forrest classification are predictive fact...

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A randomized trial comparing heater probe plus thrombin with heater probe plus placebo for bleeding peptic ulcer

Cited by 31 publications

References 29 publications

Management of Patients With Ulcer Bleeding

Management of Patients With Ulcer Bleeding

The role of endoscopy in the management of acute non-variceal upper GI bleeding

Les hémorragies digestives ulcéreuses au CHU Hassan-II de Fès: approche épidémiologique

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