Injection therapy alone or with endoscopic hemoclip for bleeding peptic ulcer, preliminary results of a randomized trial

Villanueva, Claudia; Balanzó, J.; Sabat, M; Gallego, A.; Ortiz, Jordí; Soriano, G.; Sainz, Sergio; Torras, Xavier; Vilardell, F.

doi:10.1016/s0016-5107(96)80282-3

Cited by 22 publications

(18 citation statements)

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“…I somewhat agree with Lin et al (22) with the conclusion in the current report and others (Swain et al [8] and Villanueva et al [21]) that currently marketed hemoclips have major limitations for emergency hemostasis of ulcers. Thermal probes, such as heater or multipolar probes, can be applied en face or tangentially for coaptive coagulation, and seem to be faster and easier to apply than currently marketed hemoclips.…”

Section: Where Next With Endoscopic Ulcer Hemostasis?supporting

confidence: 91%

“…Villanueva et al from Spain also reported a randomized trial of epinephrine injection alone compared with epinephrine injection plus hemoclips for treatment of bleeding peptic ulcers. A total of 250 patients with active bleeding (spurting or oozing) or NBVV on ulcers were included (21). Although initial hemostasis rates were comparable (92-94%), rebleeding rates were significantly higher in the patients with active bleeding treated with injection alone (33%, 12 of 36) compared with injection and hemoclips (10%, three of 31).…”

Section: Where Next With Endoscopic Ulcer Hemostasis?mentioning

confidence: 99%

“…Similar limitations of hemoclipping for ulcer hemostasis have been previously reported. In a randomized, controlled trial of hemoclipping versus injection, Villanueva et al (21) reported that hemoclips could not be placed, or once deployed came off the ulcer base in 16% of patients randomized to hemoclipping (Olympus). All those patients had been treated successfully with epinephrine injection therapy (21).…”

Section: Where Next With Endoscopic Ulcer Hemostasis?mentioning

confidence: 99%

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Where next with endoscopic ulcer hemostasis?

Jensen¹

2002

Am J Gastroenterology

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Section: Where Next With Endoscopic Ulcer Hemostasis?supporting

confidence: 91%

Section: Where Next With Endoscopic Ulcer Hemostasis?mentioning

confidence: 99%

Section: Where Next With Endoscopic Ulcer Hemostasis?mentioning

confidence: 99%

See 1 more Smart Citation

Where next with endoscopic ulcer hemostasis?

Jensen¹

2002

Am J Gastroenterology

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“…They were not able to place the clips in 2 patients (5%) because of technical difficulties. In contrast, Villanueva et al (11) reported that hemoclips could not be placed in about 19% of patients with bleeding chronic peptic ulcers. The majority of these patients had chronic ulcers with fibrotic bases, and hemoclips would not adhere to the ulcer base or the stigmata.…”

Section: Discussionmentioning

confidence: 94%

Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children

Ünal¹,

Çakır²,

Baran³

et al. 2014

Turk J Gastroenterol

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Background/Aims: Data about the efficiency and outcome of therapeutic endoscopic techniques in children with nonvariceal upper gastrointestinal bleeding (UGB) are scarce. We aimed to analyze our experience with endoscopic hemoclip application in children with non-variceal UGB. Materials and Methods: During a 3-year period, a total of 1715 endoscopies were performed in our pediatric endoscopy unit; 182 (10.6%) of them were performed for UGB to 158 patients. Fifty-six of them had emergent endoscopy. Among them, 15 cases with nonvariceal UGB were only given endoscopic hemoclips. Demographic, clinical, and laboratory findings at initial admission; endoscopic appearance of bleeding lesions; and outcome of hemoclip application were recorded from the hospital files and endoscopy records. Results: Ten patients (66.6%) had gastric ulcer, 3 (20%) had duodenal ulcer, 1 (6.7%) had Dieulafoy lesion, and 1 (6.7%) had bleeding at the post-polypectomy site. Initial homeostasis after hemoclip application was achieved in all patients (100%). Rebleeding was seen in only one patient (6.5%) with a Dieulafoy lesion, who needed hemoclip application for a second time, and the bleeding was controlled successfully. Permanent hemostasis was 100%. The median number of hemoclips used per case and per application was 3.4 and 3.2, respectively. None of the patients experienced any complication related to hemoclip application. Median duration of hospitalization was 6 days. On follow-up, none of the patients received surgical therapy, and 30-d mortality related to bleeding was 0%. Conclusion: The use of hemoclips for nonvariceal UGB in children is an effective modality to control bleeding without any complications in children.

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“…The haemoclip has been reported to be successful in uncontrolled studies of both variceal46 and non-variceal47 48 upper gastrointestinal bleeding, though a rebleed rate of around 11% still occurred. Provisional results from a randomised trial comparing clips and adrenaline with injection of adrenaline only showed a trend towards lower rebleeding for clips and injection in comparison with injection72 only.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels

Hepworth

Kadirkamanathan

Feng

et al. 1998

Gut

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Background and aims-A randomised controlled comparison of haemostatic efficacy of mechanical, injection, and thermal methods of haemostasis was undertaken using canine mesenteric vessels to test the hypothesis that mechanical methods of haemostasis are more effective in controlling haemorrhage than injection or thermal methods. The diameter of arteries in human bleeding ulcers measures up to 3.45 mm; mesenteric vessels up to 5 mm were therefore studied. Methods-Mesenteric vessels were randomised to treatment with injection sclerotherapy (adrenaline and ethanolamine), bipolar diathermy, or mechanical methods (band, clips, sewing machine, endoloops). The vessels were severed and haemostasis recorded. Results-Injection sclerotherapy and clips failed to stop bleeding from vessels of 1 mm (n=20) and 2 mm (n=20). Bipolar diathermy was eVective on 8/10 vessels of 2 mm but failed on 3 mm vessels (n=5). Unstretched elastic bands succeeded on 13/15 vessels of 2 mm but on only 3/10 vessels of 3 mm. The sewing machine achieved haemostasis on 8/10 vessels of 4 mm but failed on 5 mm vessels (n=5); endoloops were eVective on all 5 mm vessels (n=5). Conclusions-Only mechanical methods were eVective on vessels greater than 2 mm in diameter. Some mechanical methods (banding and clips) were less eVective than expected and need modification. Thermal and (eVective) mechanical methods were significantly (p<0.01) more eVective than injection sclerotherapy. The most eVective mechanical methods were significantly more eVective (p<0.01) than thermal or injection on vessels greater than 2 mm. (Gut 1998;42:462-469)

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Injection therapy alone or with endoscopic hemoclip for bleeding peptic ulcer, preliminary results of a randomized trial

Cited by 22 publications

References 0 publications

Where next with endoscopic ulcer hemostasis?

Where next with endoscopic ulcer hemostasis?

Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children

A randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels

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