Comparison of haemostatic efficacy for endoscopic injection therapy of epinephrine and combination therapy of epinephrine and hemoclips for bleeding peptic ulcers

Introduction. Endoscopic injection therapy of epinephrine is safe and effective in the treatment of bleeding peptic ulcer, but with high risk of rebleeding. The combination therapy of epinephrine and hemoclips could lead to a reduction of rebleeding and a potential reduction in mortality. Objective. To investigate the efficacy and safety of epinephrine injection therapy and combination therapy with epinephrine and hemoclips in treating bleeding peptic ulcers. Methods. A prospective randomized study included 58 patients with bleeding gastric or duodenal ulcer. In 30 patients endoscopic injection therapy with diluted epinephrine was applied (group I), while in 28 patients combination therapy of epinephrine and hemoclips was applied (group II). Results. Initial haemostasis was achieved in most patients treated with epinephrine injection therapy (93.3%) and patients treated with combination therapy of epinephrine and hemoclips (96.4%). After initial haemostasis was achieved rebleeding was significantly more frequent in the patients treated with epinephrine (28.5%) than in the patients treated with combination therapy (3.7%, p<0.05). Two patients treated with epinephrine injection therapy were subjected to surgical intervention, whereas no patient treated with combination therapy needed surgery. Lethal ending occurred in one patient treated with epinephrine and in one patient treated with combination therapy. The difference between the two groups of patients in need for surgical intervention and mortality was not statistically significant. Conclusion. Combination therapy with epinephrine and hemoclips is more efficient than epinephrine alone in the treatment of bleeding peptic ulcers.

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Could application of epinephrine improve hemostatic efficacy of hemoclips for bleeding peptic ulcers? A prospective randomized study

Vojnosanitetski pregled ◽

10.2298/vsp110411009g ◽

2013 ◽

Vol 70 (9) ◽

pp. 824-829 ◽

Cited By ~ 4

Author(s):

Sasa Grgov ◽

Biljana Radovanovic-Dinic ◽

Tomislav Tasic

Keyword(s):

Combination Therapy ◽

Combined Therapy ◽

Randomized Study ◽

Limiting Factors ◽

Prospective Randomized Study ◽

Peptic Ulcers ◽

Endoscopic Method ◽

Group I ◽

Bleeding Peptic Ulcers ◽

Group Ii

Background/Aim. Bleeding from peptic ulcers can be effectively and safely treated with endoscopic hemoclips therapy. However, due to certain limiting factors of hemoclips, application of combination with another endoscopic method may give better results. The aim of this study was to examine the efficacy and safety of endoscopic hemoclips therapy and to evaluate potential benefits of this therapy combined with epinephrine in the treatment of bleeding peptic ulcers. Methods. This prospective randomized study included 70 patients with bleeding gastric or duodenal ulcer. In 34 of the patients endoscopic hemoclips therapy was applied (group I), and in 36 of them a combined therapy of hemoclips and epinephrine (group II). Results. Initial hemostasis was achieved in most patients treated with endoscopic hemoclips therapy (94.1%) as well as in the patients treated with combination therapy (97.2%). After initial hemostasis achieved rebleeding occurred in 3 (9.3%) patients treated with hemoclips and in 2 (5.7%) patients treated with combination therapy, but this difference was not statistically significant (p > 0.05). The difference in the achieved final hemostasis between the group I (91.1%) and the group II (94.4%) was not statistically significant. Also, the differences between the two groups of patients in the need for blood transfusions, length of hospital stay, need for surgery and mortality were not statistically significant (p > 0.05). Conclusion. Endoscopic hemoclips therapy is effective and safe in treatment of bleeding peptic ulcers. Combination therapy of hemoclips and epinephrine has no advantage over hemoclips monotherapy.

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Endoscopic Injection Therapy in Bleeding Peptic Ulcers. Low Mortality in a High Risk Population

Canadian Journal of Gastroenterology ◽

10.1155/1992/416485 ◽

1992 ◽

Vol 6 (5) ◽

pp. 265-268 ◽

Cited By ~ 1

Author(s):

Joaqulm Balanzó ◽

Candid Villanueva ◽

Jorge C Espinós ◽

Sergio Sáinz ◽

German Soriano ◽

...

Keyword(s):

High Risk ◽

Injection Therapy ◽

High Risk Population ◽

Peptic Ulcers ◽

Endoscopic Injection ◽

Simple Method ◽

Arterial Bleeding ◽

Bleeding Peptic Ulcers ◽

Initial Control ◽

Bleeding Ulcers

Endoscoric injection therapy was performed in 341 patients consecutively admitted with a bleeding peptic ulcer at high risk of further hemorrhage, assessed by the presence of active arterial bleeding or a nonbleeding visible vessel at emergency endoscopy. Initial hemostasis was achieved in 111 of 119 actively bleeding patients (93%). Rebleeding ocurred in 75 cases (23%), at a mean interval of 53±52 h. A second emergency injection was a ttempted in 36 therapeutic failures, and was successful in 20 (55%). Emergency surgery was finally required in 52 patients (15%). Overall mortality was 4.9%. Major complications occurred in four patients (1.2%) (two perforations and two aspiration pneumonia); therefore, injection therapy is an effective and simple method for treating bleeding ulcers, achieving the initial control of hemorrhage in a majority of cases although the rate of further hemorrhage is not negligible and complications are not irrelevant.

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Intramural hematoma: a rare complication of endoscopic injection therapy for bleeding peptic ulcers

Endoscopy ◽

10.1055/s-0029-1214927 ◽

2011 ◽

Vol 43 (S 02) ◽

pp. E141-E142 ◽

Cited By ~ 8

Author(s):

A. Sadio ◽

P. Peixoto ◽

E. Cancela ◽

A. Castanheira ◽

V. Marques ◽

...

Keyword(s):

Rare Complication ◽

Intramural Hematoma ◽

Injection Therapy ◽

Peptic Ulcers ◽

Endoscopic Injection ◽

Bleeding Peptic Ulcers

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Improvement of Short-Term Outcomes for High-Risk Bleeding Peptic Ulcers With Addition of Argon Plasma Coagulation Following Endoscopic Injection Therapy

Medicine ◽

10.1097/md.0000000000001343 ◽

2015 ◽

Vol 94 (32) ◽

pp. e1343 ◽

Cited By ~ 2

Author(s):

Huay-Min Wang ◽

Wei-Lun Tsai ◽

Hsien-Chung Yu ◽

Hoi-Hung Chan ◽

Wen-Chi Chen ◽

...

Keyword(s):

High Risk ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Injection Therapy ◽

Peptic Ulcers ◽

Short Term ◽

Endoscopic Injection ◽

Plasma Coagulation ◽

Bleeding Peptic Ulcers

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Can probiotics improve efficiency and safety profile of triple Helicobacter pylori eradication therapy? A prospective randomized study

Vojnosanitetski pregled ◽

10.2298/vsp150415127g ◽

2016 ◽

Vol 73 (11) ◽

pp. 1044-1049 ◽

Cited By ~ 3

Author(s):

Sasa Grgov ◽

Tomislav Tasic ◽

Biljana Radovanovic-Dinic ◽

Daniela Benedeto-Stojanov

Keyword(s):

Helicobacter Pylori ◽

Randomized Study ◽

Eradication Therapy ◽

Saccharomyces Boulardii ◽

Rapid Urease Test ◽

Group I ◽

Urease Test ◽

Probiotic Strains ◽

The Difference ◽

H Pylori

Background/Aim. Some studies suggest the benefit of applying different probiotic strains in combination with antibiotics in the eradication of Helicobacter pylori (H. pylori) infection. The aim of this study was to evaluate the effect of co-administration of multiple probiotic strains with triple H. pylori eradication therapy. Methods. This prospective study included 167 patients with dyspeptic symptoms and chronic gastritis who were diagnosed with H. pylori infection and randomized into two groups. The group I of 77 patients underwent triple eradication therapy, for 7 days, with lansoprazole, 2 ? 30 mg half an hour before the meal, amoxicillin 2 ? 1.000 mg per 12 hours and clarithromycin 2 ? 500 mg per 12 hours. After the 7th day of the therapy, lansoprazole continued at a dose of 30 mg for half an hour before breakfast for 4 weeks. The group II of 90 patients received the same treatment as the patients of the group I, with the addition of the probiotic cultures in the form of a capsule comprising Lactobacillus Rosell-52, Lactobacillus Rosell-11, Bifidobacterium Rosell-1755 and Saccharomyces boulardii, since the beginning of eradication for 4 weeks. Eradication of H. pylori infection control was performed 8 weeks after the therapy by rapid urease test and histopathologic evaluation of endoscopic biopsies or by stool antigen test for H. pylori. Results. Eradication of H. pylori infection was achieved in 93.3% of the patients who received probiotics with eradication therapy and in 81.8% of patients who were only on eradication therapy without probiotics. The difference in eradication success was statistically significant, (p < 0.05). The incidence of adverse effects of eradication therapy was higher in the group of patients who were not on probiotic (28.6%) than in the group that received probiotic (17.7%), but the difference was not statistically significant. Conclusion. Multiple probiotic strains addition to triple eradication therapy of H. pylori achieves a significantly better eradication success, with fewer side effects of antibiotics.

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