Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers

Chung, Sydney S.C.; Lau, James Y.; Sung, Joseph J.Y.; Chan, Angus C.W.; Lai, Chi Wai; Ng, Enders K.; Chan, Francis K.L.; Yung, Man Yee; Li, Arthur K.C.

doi:10.1136/bmj.314.7090.1307

Cited by 205 publications

(114 citation statements)

References 24 publications

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“…No intervention was performed in 3 (16.7%) patients. The fact that combination therapy is more effective was also seen in a study by Chung et al, [15] who demonstrated that patients having UGIB secondary to an ulcer that was spurting blood, dual therapy with epinephrine injection and thermal therapy, produced better outcomes compared to the injection therapy alone.…”

Section: Discussionmentioning

confidence: 71%

Upper gastrointestinal bleeding in patients with end stage renal disease: causes, characteristics and factors associated with need for endoscopic therapeutic intervention

Laeeq

Tasneem

Hanif

et al. 2017

Journal of Translational Internal Medicine

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Background and Objectives: The risk of upper gastrointestinal bleeding (UGIB) is increased among the end-stage renal disease (ESRD) patients. The aim of the current study was to describe the causes and characteristics of UGIB in ESRD patients at our center and to assess the need for endoscopic therapeutic intervention (ETI) using Rockall (RS) and Glasgow Blatchford scores (GBS). Material and Methods: All patients with ESRD and UGIB with age ≥14 years were included. Frequencies and percentages were computed for categorical variables. Chi square test or Fischer's exact test was used for statistical analysis. Results: A total of 59 subjects had a mean age of 47.25 ± 15 years.The most common endoscopic findings seen were erosions in 33 (55.9%) patients, followed by ulcers in 18 (30.3%) patients. ETI was required in 33 (55.9%) patients, which included adrenaline injection in 19 (32.3%), hemoclip in 9 (15.2%) and argon plasma coagulation in 5 (8.4%) patients. Factors associated with the need of ETI were identified as: a combined presentation of hematemesis and melena (P=0.033), ulcer (P=0.002) and associated chronic liver disease (P=0.015). Six (10.1%) patients died. Death was more common if ETI was not performed (P=0.018). Conclusion: ETI was more commonly required in patients on maintenance hemodialysis with UGIB, who had presence of combined hematemesis and melena, ulcers and associated chronic liver disease. A Glasgow Blatchford score of >14 was helpful in assessing the need for ETI in these patients.

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Section: Discussionmentioning

confidence: 71%

Upper gastrointestinal bleeding in patients with end stage renal disease: causes, characteristics and factors associated with need for endoscopic therapeutic intervention

Laeeq

Tasneem

Hanif

et al. 2017

Journal of Translational Internal Medicine

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“…20 The epinephrine stops bleeding, allowing a clear view of the vessel and increasing the likelihood that the thermal device will provide firm tamponade in the appropriate place. In a canine model, thermocoagulation consistently sealed bleeding arteries that were up to 2 mm in size.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intravenous Omeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcers

et al. 2000

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“…42 Combination therapy with HPT and adrenaline in the treatment of actively bleeding peptic ulcers resulted in haemostasis in up to 98.6%, with re-bleeding in 8.2%, 43 although added benefit is confined to high risk lesions. 26 When used alone, HPT was not superior to combination treatment with adrenaline and polidocanol in patients with Forrest type I, IIa and IIb ulcers. 44 There is no incremental benefit of adding thrombin to HPT in patients with bleeding peptic ulcers with regards to haemostasis, re-bleeding rates, requirement for surgery, adverse events or mortality.…”

Section: Endoscopic Managementmentioning

confidence: 91%

“…24 Although injection with adrenaline is successful in achieving initial haemostasis, 15-36% of patients rebleed, a figure that is unacceptably high. 25,26 Sclerosants such as ethanol, polidocanol and ethanolamine are equally effective as adrenaline but carry more risk. 25,[27][28][29] In one study, ethanol injection alone was shown to have a re-bleeding rate as low as 4%; 30 however, most other published studies have achieved similar haemostasis to adrenaline alone.…”

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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Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers

Abstract: Objective: To determine whether raised plasma glucose concentration independently influences outcome after acute stroke or is a stress response reflecting increased stroke severity.

Cited by 205 publications

References 24 publications

Upper gastrointestinal bleeding in patients with end stage renal disease: causes, characteristics and factors associated with need for endoscopic therapeutic intervention

Upper gastrointestinal bleeding in patients with end stage renal disease: causes, characteristics and factors associated with need for endoscopic therapeutic intervention

Effect of Intravenous Omeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcers

Nonvariceal Upper Gastrointestinal Bleeding

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