Brief Article
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World J Gastroenterol. May 14, 2012; 18(18): 2219-2224
Published online May 14, 2012. doi: 10.3748/wjg.v18.i18.2219
Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding
Neven Ljubicic, Ivan Budimir, Alen Biscanin, Marko Nikolic, Vladimir Supanc, Davor Hrabar, Tajana Pavic
Neven Ljubicic, Ivan Budimir, Alen Biscanin, Marko Nikolic, Vladimir Supanc, Davor Hrabar, Tajana Pavic, Department of Internal Medicine, ‘Sestre milosrdnice’ University Hospital Center, 10000 Zagreb, Croatia
Author contributions: All authors made substantial contributions to all of the following: the conception and design of the study, acquisition of data, analysis and interpretation of data; Ljubicic N made substantial contributions to conception and design, drafting the article and revising it critically for important intellectual content; Budimir I participated in data collection, analysis and interpretation; Biscanin A, Nikolic M, Supanc V, Hrabar D and Pavic T contributed to collection of patients and performed endoscopic procedures.
Correspondence to: Neven Ljubicic, Professor, MD, PhD, FACG, Department of Internal Medicine, “Sestre milosrdnice” University Hospital Center, Vinogradska 29, 10000 Zagreb, Croatia.
Telephone: +385-1-3768286 Fax: +385-1-3768286
Received: August 22, 2011
Revised: December 22, 2011
Accepted: March 9, 2012
Published online: May 14, 2012

AIM: To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.

METHODS: Between January 2005 and December 2009, 150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed (Forrest IIa) were included in the study. Patients were randomized to receive a small-volume epinephrine group (15 to 25 mL injection group; Group 1, n = 50), a large-volume epinephrine group (30 to 40 mL injection group; Group 2, n = 50) and a hemoclip group (Group 3, n = 50). The rate of recurrent bleeding, as the primary outcome, was compared between the groups of patients included in the study. Secondary outcomes compared between the groups were primary hemostasis rate, permanent hemostasis, need for emergency surgery, 30 d mortality, bleeding-related deaths, length of hospital stay and transfusion requirements.

RESULTS: Initial hemostasis was obtained in all patients. The rate of early recurrent bleeding was 30% (15/50) in the small-volume epinephrine group (Group 1) and 16% (8/50) in the large-volume epinephrine group (Group 2) (P = 0.09). The rate of recurrent bleeding was 4% (2/50) in the hemoclip group (Group 3); the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution (P = 0.0005 and P = 0.045, respectively). Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups.

CONCLUSION: Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.

Keywords: Peptic ulcer, Hemorrhage, Hemoclip, Epinephrine, Nonvariceal upper gastrointestinal bleeding