مرکز منطقه ای اطلاع رساني علوم و فناوري - Comparation of endoscopic dual versus monotherapy in patients with high-risk bleeding ulcers: a retrospective trial

Abstract :

Aim. Peptic ulcer bleeding is a common medical emergency and a potentially life-threatening event. Endoscopic treatment reduces the morbidity and mortality associated with peptic ulcer bleeding. The aim of this study is to compare the efficacy of dual endoscopic therapies versus endoscopic monotherapy in reducing rate of recurrent bleeding, need for surgery, and death in patients with active peptic ulcer bleeding. Method. Data of 125 patients who applied to Akdeniz University Hospital with active bleeding, or high-risk ulcers detected by endoscopy were retrospectively investigated. Epinephrine alone injection was applied to 43 patients and epinephrine plus heater probe treatment were applied to 33 patients. Gold probe and epinephrine injection combination were applied to 29 patients and only heater probe treatment was applied to 20 patients. Results. Initial endoscopic haemostasis was achived in 39/43 patients (81.7%) who received epinephrine injection alone, 33/33 patients (100%) who received additional heater probe treatment, 28/29 patients (86.4%) who received additional gold probe treatment, and 19/20 patients (95%) who received heater probe treatment alone. Treatment outcome was determined in four treatment groups by clinical rebleeding ratios during the hospital stay. Clinical rebleeding was observed in 6 patients (15.4%) in the epinephrine alone group, in 2 patients (6.1%) in additional heater probe treatment group, in 3 patients (10.7%) in additional gold probe group, and in 2 patients (10.5%) in heater probe treatment alone group. We did not find a significant difference between these four groups by means of clinical rebleeding ratios. There was no statistically significant difference in four groups. Requirement for emergent operation was observed in 6 patients, and mean blood transfusion was 3.2±2.88 units, and mean hospital stay was 5.18±2.88 days. Conclusion. Addition of heater probe and gold probe treatment after endoscopic adrenaline injection could have an advantage in bleeding and high-risk ulcers. Lack of statistical difference between the groups could be due to low number of patients.