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. 1990 Jul;31(7):753–757. doi: 10.1136/gut.31.7.753

Heat probe thermocoagulation and pure alcohol injection in massive peptic ulcer haemorrhage: a prospective, randomised controlled trial.

H J Lin 1, F Y Lee 1, W M Kang 1, Y T Tsai 1, S D Lee 1, C H Lee 1
PMCID: PMC1378529  PMID: 2196207

Abstract

We conducted a prospective randomised controlled trial of 137 patients with massive peptic ulcer haemorrhage over a period of 12 months to compare the haemostatic effects of endoscopic heat probe thermocoagulation and pure alcohol injection. Seventy eight patients (56.9%) were in shock at the time of randomisation to the trial. The age, sex, number of patients in shock, haemoglobin value at the time of entry to the trial, number of patients with severe medical illness, location of bleeders, and stigmata of recent haemorrhage were comparable among the heat probe, pure alcohol, and control groups. The initial haemostatic effect of the heat probe was better than that of the pure alcohol injection (44 of 45 v 31 of 46, p = 0.0004). The ultimate haemostasis achieved by the heat probe group (41 of 45) was better than that of the pure alcohol group (31 of 46, p = 0.012) and of controls (24 of 46, p = 0.0001). The duration of hospital stay was shorter for patients in the heat probe group than for the control group (6.2 days v 13.8 days, p less than 0.05). The incidence of emergency surgery was less for the heat probe than the control group (three of 45 v 12 of 46, p = 0.027). The mortality rate was less in the heat probe than in the control group (one of 45 v seven of 46, p = 0.031). We suggest that heat probe thermocoagulation should be the first treatment of choice for arrest of massive peptic ulcer haemorrhage.

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Selected References

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  1. Allan R., Dykes P. A study of the factors influencing mortality rates from gastrointestinal haemorrhage. Q J Med. 1976 Oct;45(180):533–550. [PubMed] [Google Scholar]
  2. Asaki S., Nishimura T., Satoh A., Ohara S., Shibuya D., Ogitsu Y., Goto Y. Endoscopic hemostasis of gastrointestinal hemorrhage by local application of absolute ethanol: a clinical study. Tohoku J Exp Med. 1983 Dec;141(4):373–383. doi: 10.1620/tjem.141.373. [DOI] [PubMed] [Google Scholar]
  3. Bornman P. C., Theodorou N. A., Shuttleworth R. D., Essel H. P., Marks I. N. Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: a prospective evaluation. Br Med J (Clin Res Ed) 1985 Jul 27;291(6490):245–247. doi: 10.1136/bmj.291.6490.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brunetaud J. M., Jensen D. M. Current status of argon laser hemostasis of bleeding ulcers. Endoscopy. 1986 May;18 (Suppl 2):40–45. doi: 10.1055/s-2007-1018426. [DOI] [PubMed] [Google Scholar]
  5. Di Felice G. Endoscopic injection treatment in patients with shock and gastrointestinal bleeding or stigmata of recent hemorrhage. Endoscopy. 1987 Sep;19(5):185–189. doi: 10.1055/s-2007-1018278. [DOI] [PubMed] [Google Scholar]
  6. Domschke W., Lederer P., Lux G. The value of emergency endoscopy in upper gastrointestinal bleeding: review and analysis of 2014 cases. Endoscopy. 1983 May;15 (Suppl 1):126–131. doi: 10.1055/s-2007-1021486. [DOI] [PubMed] [Google Scholar]
  7. Fleischer D. Etiology and prevalence of severe persistent upper gastrointestinal bleeding. Gastroenterology. 1983 Mar;84(3):538–543. [PubMed] [Google Scholar]
  8. Fuchs K. H., Wirtz H. J., Schaube H., Elfeldt R. Initial experience with thrombin as injection agent for bleeding gastroduodenal lesions. Endoscopy. 1986 Jul;18(4):146–148. doi: 10.1055/s-2007-1018357. [DOI] [PubMed] [Google Scholar]
  9. Fuster F., Piqué J. M., Terés J., Bordas J. M., Perez R. M., Rodés J. Predictive clinical factors of visible vessel in bleeding peptic ulcer. Endoscopy. 1987 Jan;19(1):11–13. doi: 10.1055/s-2007-1018217. [DOI] [PubMed] [Google Scholar]
  10. Griffiths W. J., Neumann D. A., Welsh J. D. The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med. 1979 Jun 21;300(25):1411–1413. doi: 10.1056/NEJM197906213002503. [DOI] [PubMed] [Google Scholar]
  11. Halprin A., Anselm K. Nd:YAG laser in treatment of seriously ill patients with gastrointestinal bleeding. Gastrointest Endosc. 1986 Jun;32(3):199–201. doi: 10.1016/s0016-5107(86)71804-x. [DOI] [PubMed] [Google Scholar]
  12. Hirao M., Kobayashi T., Masuda K., Yamaguchi S., Noda K., Matsuura K., Naka H., Kawauchi H., Namiki M. Endoscopic local injection of hypertonic saline-epinephrine solution to arrest hemorrhage from the upper gastrointestinal tract. Gastrointest Endosc. 1985 Oct;31(5):313–317. doi: 10.1016/s0016-5107(85)72213-4. [DOI] [PubMed] [Google Scholar]
  13. Johnston J. H. Endoscopic hemostasis for bleeding peptic ulcer. Gastrointest Endosc. 1987 Jun;33(3):260–262. doi: 10.1016/s0016-5107(87)71577-6. [DOI] [PubMed] [Google Scholar]
  14. Johnston J. H., Jensen D. M., Auth D. Experimental comparison of endoscopic yttrium-aluminum-garnet laser, electrosurgery, and heater probe for canine gut arterial coagulation. Importance of compression and avoidance of erosion. Gastroenterology. 1987 May;92(5 Pt 1):1101–1108. doi: 10.1016/s0016-5085(87)91065-1. [DOI] [PubMed] [Google Scholar]
  15. Johnston J. H., Sones J. Q., Long B. W., Posey E. L. Comparison of heater probe and YAG laser in endoscopic treatment of major bleeding from peptic ulcers. Gastrointest Endosc. 1985 Jun;31(3):175–180. doi: 10.1016/s0016-5107(85)72039-1. [DOI] [PubMed] [Google Scholar]
  16. Johnston J. H. The sentinel clot/visible vessel revisited. Gastrointest Endosc. 1986 Jun;32(3):238–239. doi: 10.1016/s0016-5107(86)71818-x. [DOI] [PubMed] [Google Scholar]
  17. Krejs G. J., Little K. H., Westergaard H., Hamilton J. K., Spady D. K., Polter D. E. Laser photocoagulation for the treatment of acute peptic-ulcer bleeding. A randomized controlled clinical trial. N Engl J Med. 1987 Jun 25;316(26):1618–1621. doi: 10.1056/NEJM198706253162602. [DOI] [PubMed] [Google Scholar]
  18. Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. A prospective controlled trial. N Engl J Med. 1987 Jun 25;316(26):1613–1617. doi: 10.1056/NEJM198706253162601. [DOI] [PubMed] [Google Scholar]
  19. Leung J. W., Chung S. C. Endoscopic injection of adrenalin in bleeding peptic ulcers. Gastrointest Endosc. 1987 Apr;33(2):73–75. doi: 10.1016/s0016-5107(87)71512-0. [DOI] [PubMed] [Google Scholar]
  20. Lin H. J., Tsai Y. T., Lee S. D., Lai K. H., Lee C. H. Heat probe therapy for severe hemorrhage from a peptic ulcer with a visible vessel. Endoscopy. 1988 Jul;20(4):131–133. doi: 10.1055/s-2007-1018156. [DOI] [PubMed] [Google Scholar]
  21. Lin H. J., Tsai Y. T., Lee S. D., Lai K. H., Lee F. Y., Lin C. Y., Lee C. H. A prospectively randomized trial of heat probe thermocoagulation versus pure alcohol injection in nonvariceal peptic ulcer hemorrhage. Am J Gastroenterol. 1988 Mar;83(3):283–286. [PubMed] [Google Scholar]
  22. Lin H. J., Tsai Y. T., Lee S. D., Lai K. H., Lee F. Y., Lin C. Y., Lee C. H. Heater probe in massive peptic ulcer hemorrhage and shock. J Clin Gastroenterol. 1988 Dec;10(6):623–626. doi: 10.1097/00004836-198812000-00009. [DOI] [PubMed] [Google Scholar]
  23. MacLeod I. A., Mills P. R. Factors identifying the probability of further haemorrhage after acute upper gastrointestinal haemorrhage. Br J Surg. 1982 May;69(5):256–258. doi: 10.1002/bjs.1800690509. [DOI] [PubMed] [Google Scholar]
  24. Northfield T. C. Factors predisposing to recurrent haemorrhage after acute gastrointestinal bleeding. Br Med J. 1971 Jan 2;1(5739):26–28. doi: 10.1136/bmj.1.5739.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Panés J., Viver J., Forné M., Garcia-Olivares E., Marco C., Garau J. Controlled trial of endoscopic sclerosis in bleeding peptic ulcers. Lancet. 1987 Dec 5;2(8571):1292–1294. doi: 10.1016/s0140-6736(87)91191-3. [DOI] [PubMed] [Google Scholar]
  26. Papp J. P. Heat probe versus BICAP probe in the treatment of upper gastrointestinal bleeding. Am J Gastroenterol. 1987 Jul;82(7):619–621. [PubMed] [Google Scholar]
  27. Pimpl W., Boeckl O., Waclawiczek H. W., Heinerman M. Estimation of the mortality rate of patients with severe gastroduodenal hemorrhage with the aid of a new scoring system. Endoscopy. 1987 May;19(3):101–106. doi: 10.1055/s-2007-1013010. [DOI] [PubMed] [Google Scholar]
  28. Protell R. L., Rubin C. E., Auth D. C., Silverstein F. E., Terou F., Dennis M., Piercey J. R. The heater probe: a new endoscopic method for stopping massive gastrointestinal bleeding. Gastroenterology. 1978 Feb;74(2 Pt 1):257–262. [PubMed] [Google Scholar]
  29. Schiller K. F., Truelove S. C., Williams D. G. Haematemesis and melaena, with special reference to factors influencing the outcome. Br Med J. 1970 Apr 4;2(5700):7–14. doi: 10.1136/bmj.2.5700.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Schuman B. M. Endoscopic injection therapy for nonvariceal upper gastrointestinal hemorrhage--is it too good to be true? Gastrointest Endosc. 1987 Apr;33(2):121–122. doi: 10.1016/s0016-5107(87)71528-4. [DOI] [PubMed] [Google Scholar]
  31. Shorvon P. J., Leung J. W., Cotton P. B. Preliminary clinical experience with the heat probe at endoscopy in acute upper gastrointestinal bleeding. Gastrointest Endosc. 1985 Dec;31(6):364–366. doi: 10.1016/s0016-5107(85)72248-1. [DOI] [PubMed] [Google Scholar]
  32. Silverstein F. E., Feld A. D., Gilbert D. A. Upper gastrointestinal tract bleeding. Predisposing factors, diagnosis, and therapy. Arch Intern Med. 1981 Feb 23;141(3 Spec No):322–327. doi: 10.1001/archinte.141.3.322. [DOI] [PubMed] [Google Scholar]
  33. Silverstein F. E., Gilbert D. A., Tedesco F. J., Buenger N. K., Persing J. The national ASGE survey on upper gastrointestinal bleeding. I. Study design and baseline data. Gastrointest Endosc. 1981 May;27(2):73–79. doi: 10.1016/s0016-5107(81)73155-9. [DOI] [PubMed] [Google Scholar]
  34. Soehendra N., Grimm H., Stenzel M. Injection of nonvariceal bleeding lesions of the upper gastrointestinal tract. Endoscopy. 1985 Jul;17(4):129–132. doi: 10.1055/s-2007-1018481. [DOI] [PubMed] [Google Scholar]
  35. Storey D. W., Bown S. G., Swain C. P., Salmon P. R., Kirkham J. S., Northfield T. C. Endoscopic prediction of recurrent bleeding in peptic ulcers. N Engl J Med. 1981 Oct 15;305(16):915–916. doi: 10.1056/NEJM198110153051603. [DOI] [PubMed] [Google Scholar]
  36. Sugawa C., Fujita Y., Ikeda T., Walt A. J. Endoscopic hemostasis of bleeding of the upper gastrointestinal tract by local injection of ninety-eight per cent dehydrated ethanol. Surg Gynecol Obstet. 1986 Feb;162(2):159–163. [PubMed] [Google Scholar]
  37. Swain C. P., Storey D. W., Bown S. G., Heath J., Mills T. N., Salmon P. R., Northfield T. C., Kirkham J. S., O'Sullivan J. P. Nature of the bleeding vessel in recurrently bleeding gastric ulcers. Gastroenterology. 1986 Mar;90(3):595–608. doi: 10.1016/0016-5085(86)91113-3. [DOI] [PubMed] [Google Scholar]
  38. The British Society of Gastroenterology. Annual meeting 28 to 30 September 1983, York. Abstracts. Gut. 1983 Oct;24(10):A967–1012. doi: 10.1136/gut.24.10.a967. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Valenzuela G. A., Lind C. D., Pambianco D. J., Stone D. D. Injection therapy for nonvariceal hemorrhage. Gastrointest Endosc. 1987 Dec;33(6):461–462. doi: 10.1016/s0016-5107(87)71694-0. [DOI] [PubMed] [Google Scholar]
  40. Wara P. Endoscopic prediction of major rebleeding--a prospective study of stigmata of hemorrhage in bleeding ulcer. Gastroenterology. 1985 May;88(5 Pt 1):1209–1214. doi: 10.1016/s0016-5085(85)80081-0. [DOI] [PubMed] [Google Scholar]
  41. Wördehoff D., Gros H. Endoscopic haemostasis by injection-therapy in high-risk patients. Endoscopy. 1982 Nov;14(6):196–199. doi: 10.1055/s-2007-1021620. [DOI] [PubMed] [Google Scholar]

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