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Peptic ulcer hemorrhage: Local injection of fibrin sealant—Experimental and clinical data

Ulkusblutung: Lokale Injektionstherapie mit Fibrinkleber —experimentelle und klinische Daten

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Abstract

This study was undertaken to assess the role of fibrin sealant in achieving early hemostasis and wound healing following endoscopic injection in peptic ulcer hemorrhage.

In an experimental study in Wistar-rats we looked at the healing rate and histological changes of laser-induced acute gastric ulcers and acetic acid-induced chronic gastric ulcers following injection of standard sclerosants as well as fibrin sealant. A statistically favourable result was observed in the fibrin treated group.

We also treated 127 patients suffering from bleeding peptic ulcers with local injection of fibrin sealant (33 Forrest stage la, 40 Forrest lb, 54 Forrest Ila) in a prospective clinical trial during the period of 1. February 1988 to 31. January 1991. A primary recurrence was noticed in 19 (14.9%) patients. With a 2. injection the hemostasis was definite in 116 of 127 patients (91.3%). Only 11 patients (8.6%) needed surgery for hemostasis. The mortality was 6.3% (8 patients).

Zusammenfassung

Die blutstillenden und wundheilungsfördernden Eigenschaften von Fibrinkleber könnten bei der endoskopischen Behandlung der gastroduodenalen Ulkusblutung hilfreich sein. Zur Klärung dieser Frage wurden folgende Untersuchungen unternommen:

Experimentell wurden an Wistar-Ratten Heilungsraten und histologische Veränderungen an laserinduzierten, akuten Ulzera und essigsäureinduzierten, chronischen Ulzera nach lokaler Injektion von bekannten Sklerotherapeutika im Vergleich zu Fibrinkleber Untersucht. Dabei fanden sich statistisch signifikante Unterschiede zugunsten des Fibrinklebers.

In einer prospektiven klinischen Untersuchung wurden vom 1. Februar 1988 bis zum 31. Januar 1991 127 Patienten mit gastroduodenaler Ulkusblutung durch lokale Fibrinkleberinjektion therapiert (33 Forrest-Stadium [F] Ia, 40 F Ib, 54 F IIa). Bei 19 Patienten (14,9%) trat eine Rezidivblutung auf. Mit einer 2. Injektionsbehandlung wurde eine definitive Blutstillung bei 116 von 127 Patienten (91.3%) erreicht. Lediglich 11 Patienten (8,6%) mußten zur Blutstillung operiert werden. Die Letalität betrug 6,3% (8 Patienten).

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Author notes

  1. R. Salm

    Present address: Chirurgische Universitätsklinik, Abteilung Allgemeine Chirurgie, Hugstetterstraße 55, D-W-7800, Freiburg, Germany

Authors and Affiliations

  1. Department of General Pathology, University Freiburg, Germany

    W. Bohle

  2. Chirurgische Universitätsklinik, Abteilung Allgemeine Chirurgie, Hugstetterstraße 55, D-W-7800, Freiburg, Germany

    J. Sontheimer

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Salm, R., Bohle, W. & Sontheimer, J. Peptic ulcer hemorrhage: Local injection of fibrin sealant—Experimental and clinical data. Acta Chir Austriaca 23, 113–116 (1991). https://doi.org/10.1007/BF02658863

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