Abstract
Background
Endoscopic high-frequency soft coagulation, recently developed in Japan, is available for the management of gastric bleeding in cases of bleeding gastric ulcers and bleeding during endoscopic submucosal dissection. The aim of this study was to evaluate the efficacy of hemostasis with soft coagulation for bleeding gastric ulcers by comparing it with hemoclips in a prospective, randomized trial.
Methods
During the period of April 2006 to March 2008, 96 patients that had gastric ulcers with bleeding or nonbleeding visible vessels were enrolled in this study. All of the 96 patients were randomly divided into two groups: endoscopic hemostasis with soft coagulation (Group I) or endoscopic hemoclipping (Group II).
Results
A total of 41 (85%) out of 48 patients in Group I and 38 (79%) out of 48 patients in Group II were successfully treated with soft coagulation or clipping alone, respectively. The endoscopic hemostasis rate for the initial modality in combination with another endoscopic procedure performed after the initial method was 98% in both groups. One patient in Group I (2%) and five patients in Group II (10%) experienced recurrent bleeding. The time required to achieve hemostasis was shorter in Group I compared with Group II (9.2 ± 11.1 vs. 13.6 ± 9.4 min; P < 0.05).
Conclusions
This study revealed that soft coagulation is as effective as hemoclipping for treating bleeding gastric ulcers. The time required to achieve hemostasis was shorter with the soft coagulation procedure.
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References
Marshall BJ, Warren JR. Unidentified curved bacilli in the stomachs of patients with gastritis and peptic ulceration. Lancet. 1984;1:1311–4.
Schubert TT, Bologna SD, Nensey Y, Schubert AB, Mascha EJ, Ma CK. Ulcer risk factors, interactions between Helicobacter pylori infection, non-steroidal use, and age. Am J Med. 1993;94:413–8.
Hentschel E, Brandstatter G, Dragosics B, Hirschl AM, Nemec H, Schütze K, et al. Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer. N Engl J Med. 1993;328:308–12.
Labenz J, Borsch G. Evidence for the essential role of Helicobacter pylori in gastric ulcer disease. Gut. 1994;35:19–22.
Van der Hulst RW, Rauws EA, Koycu B, Keller JJ, Bruno MJ, Tijssen JG, et al. Prevention of ulcer recurrence after eradication of Helicobacter pylori: a prospective long-term follow-up study. Gastroenterology. 1997;113:1082–6.
Kikkawa A, Iwakiri R, Ootani H, Ootani A, Fujise T, Sakata Y, et al. Prevention of the rehaemorrhage of bleeding peptic ulcer: effects of Helicobacter pylori eradication and acid suppression. Aliment Pharmacol Ther. 2005;21:79–84.
British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal hemorrhage: guidelines. Gut. 2002;51:41–6.
Koyama T, Fujimoto K, Iwakiri R, Sakata H, Sakata Y, Yamaoka K, et al. Prevention of recurrent bleeding from gastric ulcer with a nonbleeding visible vessel by endoscopic injection of absolute ethanol: a prospective, controlled trial. Gastrointest Endosc. 1995;42:128–31.
Ootani H, Iwakiri R, Shimoda R, Nakahara S, Amemori S, Fujise T, et al. Role of Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use in bleeding gastric ulcers in Japan. J Gastroenterol. 2006;41:41–6.
Raju GS, Kaltenbach T, Soetikno R. Endoscopic mechanical hemostasis of GI arterial bleeding. Gastrointest Endosc. 2007;66:774–85.
Chan FK. Proton-pump inhibitors in peptic ulcer disease. Lancet. 2008;372:1198–200.
Yamaguchi M, Iwakiri R, Yamaguchi K, Mizuta T, Shimoda R, et al. Bleeding and stenosis caused by reflux esophagitis was not common in emergency endoscopic examination: a retrospective patient chart review at a single institution in Japan. J Gastroenterol. 2008;43:265–9.
Shimoda R, Iwakiri R, Sakata H, Ogata S, Ootani H, Sakata Y, et al. Endoscopic hemostasis with metallic hemoclips for iatrogenic Malloy–Weiss tear caused by endoscopic examination. Dig Endosc. 2009;21:20–3.
Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection—an analysis of risk factors. Endoscopy. 2008;40:179–83.
Storey DW, Bowed SG, Swain CP, Salmon PR, Kirkham JS, Northfield TC. Endoscopic prediction of recurrent bleeding in peptic ulcers. N Eng J Med. 1981;305:915–6.
Jensen DM. Spots and clots-leave them or treat them? Why and how to treat. Can J Gastroenterol. 1999;13:413–5.
Sugiyama T, Dozaiku T, Toyonaga T, Hirooka T, Ueda C, Iwata Y, et al. The usefulness of 4 + 1 contact method using soft coagulation for bleeding gastric ulcers (in Japanese with English abstract). Gastroenterol Endosc. 2006;48:204–11.
Nagayama K, Tazawa J, Sakai Y, Miyasaka Y, Yu SH, Sakuma I, et al. Efficacy of endoscopic clipping for bleeding gastroduodenal ulcer: comparison with topical ethanol injection. Am J Gastroenterol. 1999;94:2897–901.
Chung IK, Ham JS, Kim HS, Park SH, Lee MH, Kim SJ. Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc. 1999;49:13–8.
Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, et al. Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointest Endosc. 2001;53:147–51.
Waring JP, Sanowski RA, Sawyer RL, Woods CA, Foutch PG. A randomized comparison of multipolar electrocoagulation and injection sclerosis for the treatment of bleeding peptic ulcer. Gastrointest Endosc. 1991;37:295–8.
Lin HJ, Chan CY, Lee FY, Huang ZC, Lee CH, Lee SD. Endoscopic injection to arrest peptic ulcer hemorrhage: a prospective, randomized controlled trial; preliminary results. Hepatogastroenterology. 1991;38:291–4.
Loren L. Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers. A prospective, randomized trial. Gastroenterology. 1990;99:1303–6.
Chung SCS, Leong HT, Chan ACW, Lau JY, Yung MY, Leung JW, et al. Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial. Gastrointest Endosc. 1996;43:591–5.
Gralnek IM, Jensen DM, Gornbein J, Kovacs TO, Jutabha R, Freeman ML, et al. Clinical and economic outcomes of individuals with severe peptic ulcer hemorrhage and nonbleeding visible vessel: an analysis of two prospective clinical trials. Am J Gastroenterol. 1998;93:2009–11.
Sung JJ, Tsoi KK, Lai LH, Wu JC, Lau JY. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut. 2007;56:1364–73.
Skok P, Krizman I, Skok M. Argon plasma coagulation versus injection sclerotherapy in peptic ulcer hemorrhage—a prospective, controlled study. Hepatogastroenterology. 2004;51:165–70.
Kanai M, Hamada A, Endo Y, Takeda Y, Yamakawa M, Nishikawa H, et al. Efficacy of argon plasma coagulation in nonvariceal upper gastrointestinal bleeding. Endoscopy. 2004;36:1085–8.
Andriulli A, Annese V, Caruso N, et al. Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta-analyses. Am J Gastroenterol. 2005;100:207–19.
Yuan Y, Wang C, Hunt RH, Pilotto A, Accadia L, Niro AG, et al. Endoscopic clipping for acute nonvariceal upper-GI bleeding: a meta-analysis and critical appraisal of randomized controlled trials. Gastrointest Endosc. 2008;68:339–51.
Shimoda R, Iwakiri R, Sakata H, Ogata S, Kikkawa A, Ootani H, et al. Evaluation of endoscopic hemostasis with metallic hemoclips for bleeding gastric ulcer: comparison with endoscopic injection of absolute ethanol in a prospective, randomized study. Am J Gastroenterol. 2003;98:2198–202.
Raju GS, Gajula L. Endosclips for GI endoscopy. Gastrointest Endosc. 2004;59:267–79.
Gever AM, DeGoede E, Simoens M, Hiele M, Rutgeerts P. A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc. 2002;55:466–9.
Nakayama M, Iwakiri R, Hara M, Ootani H, Shimoda R, Tsunada S, et al. Low-dose aspirin is a prominent cause of bleeding ulcers in patients who underwent emergency endoscopy. J Gastroenterol. 2009;44:912–8.
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Arima, S., Sakata, Y., Ogata, S. et al. Evaluation of hemostasis with soft coagulation using endoscopic hemostatic forceps in comparison with metallic hemoclips for bleeding gastric ulcers: a prospective, randomized trial. J Gastroenterol 45, 501–505 (2010). https://doi.org/10.1007/s00535-009-0186-8
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DOI: https://doi.org/10.1007/s00535-009-0186-8