Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding

Znanstveni rad - Izvorni znanstveni rad

• Autor: Neven Ljubičić
• Autor: Ivan Budimir
• Autor: Alen Bišćanin
• Autor: Marko Nikolić
• Autor: Vladimir Supanc
• Autor: Davor Hrabar
• Autor: Tajana Pavić
• Autorova ustanova: Sveučilište u Zagrebu; Medicinski fakultet
• Znanstveno / umjetničko područje, polje i grana: BIOMEDICINA I ZDRAVSTVO; Kliničke medicinske znanosti

Sažetak (engleski)

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.

• Ključne riječi (engleski): Adult; Aged; Aged, 80 and over; Blood Transfusion; Chi-Square Distribution; Combined Modality Therapy; Croatia; Duodenal Ulcer/mortality; Duodenal Ulcer/therapy; Epinephrine/administration & dosage; Epinephrine/adverse effects; Equipment Design; Female; Hemostasis, Endoscopic/adverse effects; Hemostasis, Endoscopic/instrumentation; Hemostasis, Endoscopic/mortality; Hemostatics/administration & dosage; Hemostatics/adverse effects; Humans; Injections; Length of Stay; Male; Middle Aged; Peptic Ulcer Hemorrhage/mortality; Peptic Ulcer Hemorrhage/therapy; Prospective Studies; Recurrence; Stomach Ulcer/mortality; Stomach Ulcer/therapy; Surgical Instruments; Time Factors; Treatment Outcome
• Jezik: engleski
• Vrsta publikacije: Znanstveni rad - Izvorni znanstveni rad
• Status objave: Objavljen
• Vrsta recenzije: Recenziran
• Verzija publikacije: Objavljena verzija rada (izdavačev PDF)
• Naslov časopisa: World Journal of Gastroenterology
• Brojčani podaci: vol. 18, br. 18, str. 2219-2224
• p-ISSN: 1007-9327
• DOI: https://doi.org/10.3748/wjg.v18.i18.2219
• URN:NBN: urn:nbn:hr:105:911150
• Datum objave publikacije: 2012-05-14
• URL dokumenta: http://dx.doi.org/10.3748/wjg.v18.i18.2219
• Vrsta resursa: Tekst
• Prava pristupa: Otvoreni pristup
• Datum i vrijeme pohrane: 2024-03-27 20:01:02