Comparison of Injection Sclerotherapy and Laser Photocoagulation for Bleeding Peptic Ulcers
| Autor: | Milorad Opačić, R. Pulanić, Zeljko Krznaric, Nataša Jokić-Begić, Marija Rosandić, Nadan Rustemović, Tomislav Brkić, B. Vucelić |
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| Rok vydání: | 1995 |
| Předmět: |
Adult
Male medicine.medical_specialty Peptic medicine.medical_treatment law.invention Polidocanol Randomized controlled trial law Sclerotherapy medicine Humans Prospective Studies Stomach Ulcer Prospective cohort study Aged Laser Coagulation medicine.diagnostic_test business.industry Hemostasis Endoscopic Gastroenterology Middle Aged Endoscopy Surgery Clinical trial Peptic Ulcer Hemorrhage Treatment Outcome Duodenal Ulcer Hemostasis Regression Analysis Female business medicine.drug |
| Zdroj: | Endoscopy. 27:291-297 |
| ISSN: | 1438-8812 0013-726X |
| DOI: | 10.1055/s-2007-1005695 |
| Popis: | Background and study aims The most widely used endoscopic procedures in the management of patients with bleeding peptic ulcer are at present sclerotherapy and thermal methods. In an attempt to assess the most effective method of achieving hemostasis, we compared injection sclerotherapy and laser photocoagulation in terms of the efficacy of initial hemostasis, rebleeding, need for surgery, mortality, and the appearance of the ulcer after the hemostatic procedure. Patients and methods In this prospective, randomized trial, 160 patients were treated with injection sclerotherapy (1% polidocanol), and 155 patients with laser photocoagulation (Nd:YAG laser) in cases of Forrest I, Forrest IIa, and Forrest IIb hemorrhage. The bleeding activity was classified according to the modified Forrest criteria. Polidocanol injection and Nd:YAG laser photocoagulation were not preceded by epinephrine administration. Results There were no significant overall differences between the groups in the outcome in terms of definitive hemostasis, rebleeding, urgent surgery, and death (p = 0.487). In the case of the subgroup with Forrest I lesions, laser photocoagulation was more efficacious than sclerotherapy (p = 0.0078). In the Forrest IIa and Forrest IIb subgroups, the two methods were equally effective (p = 0.202 and 0.513 respectively). In the sclerotherapy patients, definitive initial hemostasis in Forrest IIa was achieved in 100%, whereas in the laser group this rate was 92%, with 28% of patients initially developing hemorrhage after one or two laser pulses. Ulcer healing was slower following sclerotherapy than after photocoagulation. Conclusion Injection sclerotherapy and laser photocoagulation are equally effective in achieving definitive hemostasis in bleeding peptic ulcers. Laser photocoagulation is more efficacious in patients with active bleeding, whereas injection sclerotherapy is more effective in patients with a nonbleeding visible vessel. |
| Databáze: | OpenAIRE |
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