Skip to main content
PMC home page
Gut logoLink to Gut
. 1991 Jul;32(7):727–729. doi: 10.1136/gut.32.7.727

Endoscopic injection sclerosis: effective treatment for bleeding peptic ulcer.

C Rajgopal 1, K R Palmer 1
PMCID: PMC1378984  PMID: 1855676

Abstract

One hundred and nine patients presenting with severe haemorrhage from benign peptic ulcers were randomised to either endoscopic injection sclerotherapy using a combination of 1:100,000 adrenaline and 5% ethanolamine or to conservative treatment. Only high risk patients with active bleeding or endoscopic stigmata of recent haemorrhage and accessible ulcers were considered. The two groups were well matched for age, shock, haemoglobin concentration, endoscopic findings, and consumption of non-steroidal anti-inflammatory drugs. The group treated endoscopically had a significantly reduced rebleeding rate (12.5% v 47%, p less than 0.001). Rebleeding was successfully treated in some patients by injection sclerotherapy, other patients underwent urgent surgery. While there was a tendency towards a lower operation rate and lower transfusion requirements in the treated group, this failed to achieve statistical significance. The use of injection sclerotherapy in the conservatively treated group after rebleeding undoubtedly reduced the number of surgical operations. Endoscopic injection sclerotherapy is effective in the prevention of rebleeding in these patients.

Full text

PDF
728

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Branicki F. J., Boey J., Fok P. J., Pritchett C. J., Fan S. T., Lai E. C., Mok F. P., Wong W. S., Lam S. K., Hui W. M. Bleeding gastric ulcer: a prospective evaluation of rebleeding and mortality. Aust N Z J Surg. 1989 Jul;59(7):551–562. doi: 10.1111/j.1445-2197.1989.tb01630.x. [DOI] [PubMed] [Google Scholar]
  2. Brearley S., Hawker P. C., Dykes P. W., Keighley M. R. Per-endoscopic bipolar diathermy coagulation of visible vessels using a 3.2 mm probe--a randomised clinical trial. Endoscopy. 1987 Jul;19(4):160–163. doi: 10.1055/s-2007-1018269. [DOI] [PubMed] [Google Scholar]
  3. Chung S. C., Leung J. W., Steele R. J., Crofts T. J., Li A. K. Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial. Br Med J (Clin Res Ed) 1988 Jun 11;296(6637):1631–1633. doi: 10.1136/bmj.296.6637.1631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Foster D. N., Miloszewski K. J., Losowsky M. S. Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding. Br Med J. 1978 May 6;1(6121):1173–1177. doi: 10.1136/bmj.1.6121.1173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. JONES F. A. Hematemesis and melena; with special reference to causation and to the factors influencing the mortality from bleeding peptic ulcers. Gastroenterology. 1956 Feb;30(2):166–190. [PubMed] [Google Scholar]
  6. Laine L. Multipolar electrocoagulation in the treatment of peptic ulcers with nonbleeding visible vessels. A prospective, controlled trial. Ann Intern Med. 1989 Apr 1;110(7):510–514. doi: 10.7326/0003-4819-110-7-510. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. MacLeod I. A., Mills P. R., MacKenzie J. F., Joffe S. N., Russell R. I., Carter D. C. Neodymium yttrium aluminium garnet laser photocoagulation for major haemorrhage from peptic ulcers and single vessels: a single blind controlled study. Br Med J (Clin Res Ed) 1983 Jan 29;286(6362):345–348. doi: 10.1136/bmj.286.6362.345. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. O'Brien J. D., Day S. J., Burnham W. R. Controlled trial of small bipolar probe in bleeding peptic ulcers. Lancet. 1986 Mar 1;1(8479):464–467. doi: 10.1016/s0140-6736(86)92928-4. [DOI] [PubMed] [Google Scholar]
  10. 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]
  11. Rutgeerts P., Vantrappen G., Broeckaert L., Coremans G., Janssens J., Hiele M. Comparison of endoscopic polidocanol injection and YAG laser therapy for bleeding peptic ulcers. Lancet. 1989 May 27;1(8648):1164–1167. doi: 10.1016/s0140-6736(89)92751-7. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. 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]
  14. 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]
  15. Swain C. P., Kirkham J. S., Salmon P. R., Bown S. G., Northfield T. C. Controlled trial of Nd-YAG laser photocoagulation in bleeding peptic ulcers. Lancet. 1986 May 17;1(8490):1113–1117. doi: 10.1016/s0140-6736(86)91835-0. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. 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]
  18. Wara P. Endoscopic electrocoagulation of major bleeding from peptic ulcer. Acta Chir Scand. 1985;151(1):29–35. [PubMed] [Google Scholar]
  19. 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]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES