Skip to main content
PMC home page
Gut logoLink to Gut
. 1981 Mar;22(3):228–233. doi: 10.1136/gut.22.3.228

Randomised trial of endoscopic argon laser photocoagulation in bleeding peptic ulcers.

A G Vallon, P B Cotton, B H Laurence, J R Armengol Miro, J C Salord Oses
PMCID: PMC1419500  PMID: 7014392

Abstract

Emergency endoscopy on 332 patients with acute upper gastrointestinal bleeding showed that 178 had peptic ulcers; 28 of these were actively bleeding (spurting) and 108 showed stigmata of recent haemorrhage (vessels or spots in the ulcer base) suggesting a risk of rebleeding. These 136 patients were randomly allocated to Argon laser photocoagulation or to no additional therapy (controls) at the time of initial endoscopy. All patients received conventional management, and the controlling clinicians did not know whether or not the laser had been used in any individual patients. The laser system proved both simple and safe in use. Initial haemostasis was achieved by the laser in 10 of 15 'spurting vessels', but four of 13 'control' spurting vessels also stopped bleeding spontaneously. Overall, there were no statistically significant differences between the laser treated and control groups in terms of rebleeding, the need for surgical intervention, or death. These results require amplification in larger trials, and comparison with other studies using different protocols and other haemostatic methods.

Full text

PDF
228

Selected References

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

  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. Bown S. G., Salmon P. R., Kelly D. F., Calder B. M., Pearson H., Weaver B. M., Read A. E. Argon laser photocoagulation in the dog stomach. Gut. 1979 Aug;20(8):680–687. doi: 10.1136/gut.20.8.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dixon J. A., Berenson M. M., McCloskey D. W. Neodymium-yag laser treatment of experimental canine gastric bleeding. Acute and chronic studies of photocoagulation, penetration, and perforation. Gastroenterology. 1979 Oct;77(4 Pt 1):647–651. [PubMed] [Google Scholar]
  4. Douglas N. J., Calverley P. M., Leggett R. J., Brash H. M., Flenley D. C., Brezinova V. Transient hypoxaemia during sleep in chronic bronchitis and emphysema. Lancet. 1979 Jan 6;1(8106):1–4. doi: 10.1016/s0140-6736(79)90451-3. [DOI] [PubMed] [Google Scholar]
  5. Dronfield M. W., McIllmurray M. B., Ferguson R., Atkinson M., Langman M. J. A prospective, randomised study of endoscopy and radiology in acute upper-gastrointestinal-tract bleeding. Lancet. 1977 Jun 4;1(8023):1167–1169. doi: 10.1016/s0140-6736(77)92713-1. [DOI] [PubMed] [Google Scholar]
  6. 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]
  7. Frühmorgen P., Bodem F., Reidenbach H. D., Demling L. Was ist gesichert in der Laserkoagulation zur Stillung gastrointestinaler Blutungen? Internist (Berl) 1978 Dec;19(12):707–712. [PubMed] [Google Scholar]
  8. Gaisford W. D. Endoscopic electrohemostasis of active upper gastrointestinal bleeding. Am J Surg. 1979 Jan;137(1):47–53. doi: 10.1016/0002-9610(79)90009-6. [DOI] [PubMed] [Google Scholar]
  9. 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]
  10. Hunt P. S., Hansky J., Korman M. G. Mortality in patients with haematemesis and melaena: a prospective study. Br Med J. 1979 May 12;1(6173):1238–1240. doi: 10.1136/bmj.1.6173.1238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Katon R. M. Experimental control of gastrointestinal hemorrhage via the endoscope: a new era dawns. Gastroenterology. 1976 Feb;70(2):272–277. [PubMed] [Google Scholar]
  12. Laurence B. H., Vallon A. G., Cotton P. B., Armengol Miro J. R., Salord Oses J. C., LeBodic L., Sudry P., Frühmorgen P., Bodem F. Endoscopic laser photocoagulation for bleeding peptic ulcers. Lancet. 1980 Jan 19;1(8160):124–125. doi: 10.1016/s0140-6736(80)90607-8. [DOI] [PubMed] [Google Scholar]
  13. Linscheer W. G., Fazio T. L. Control of upper gastrointestinal hemorrhage by endoscopic spraying of clotting factors. Gastroenterology. 1979 Oct;77(4 Pt 1):642–646. [PubMed] [Google Scholar]
  14. Matek W., Frühmorgen P., Kaduk B., Reidenbach H. D., Bodem F., Demling L. Modified electrocoagulation and its possibilities in the control of gastrointestinal bleeding. Endoscopy. 1979 Nov;11(4):253–258. doi: 10.1055/s-0028-1098361. [DOI] [PubMed] [Google Scholar]
  15. Papp J. P. Endoscopic electrocoagulation of actively bleeding arterial upper gastrointestinal lesions. Am J Gastroenterol. 1979 May;71(5):516–521. [PubMed] [Google Scholar]
  16. Silverstein F. E. A staunch approach to endoscopic therapy. Gastroenterology. 1979 Oct;77(4 Pt 1):797–798. [PubMed] [Google Scholar]
  17. Silverstein F. E., Protell R. L., Gilbert D. A., Gulacsik C., Auth D. C., Dennis M. B., Rubin C. E. Argon vs. neodymium YAG laser photocoagulation of experimental canine gastric ulcers. Gastroenterology. 1979 Sep;77(3):491–496. [PubMed] [Google Scholar]
  18. Thomas G. E., Cotton P. B., Clark C. G., Boulos P. B. Survey of management in acute upper gastrointestinal haemorrhage. J R Soc Med. 1980 Feb;73(2):90–95. [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES