polidocanol and Peptic-Ulcer

A prospective, randomized study was performed to compare the hemostatic effect of injection therapy and heater probe thermocoagulation in the treatment of peptic ulcer bleeding.. This study includes 104 patients with upper gastrointestinal bleeding in whom endoscopy revealed a gastric or duodenal ulcer with nonbleeding or bleeding vessel (n = 66), oozing hemorrhage (n = 21), or adherent red clot (n = 17). Patients with other stigmata or clean ulcers were excluded. Patients were randomly assigned during endoscopy to receive injection therapy (adrenaline and polidocanol) (n = 51) or heater probe thermocoagulation (10F probe, at setting of 30 J (n = 53). Therapy was considered successful if there was no further hemorrhage or only minor rebleeding that was controlled with a second endoscopic procedure. Patients with major rebleeding or failure of retreatment underwent emergency surgery.. There were no significant differences in effectiveness between injection therapy and thermocoagulation in any of the assessed parameters: the percentage of patients with major recurrent hemorrhage (4% vs 6%) or minor rebleeding (16% vs 17%), need for emergency surgery (two patients from each group), transfusion requirement (0.45 +/- 0.9 units vs 0.51 +/- 1.1 units), the mean number of hospitalization days (7.1 +/- 4.2 vs 6.9 +/- 4.9), and mortality (one patient from each group died).. Injection therapy and heater probe have similar efficacies in the treatment of bleeding peptic ulcers.

Topics: Adrenergic Agonists; Electrocoagulation; Epinephrine; Female; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Peptic Ulcer; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Treatment Outcome

392 patients were examined by endoscopy for acute upper gastrointestinal bleeding; 140 had ulcers containing an actively bleeding visible vessel or a non-bleeding visible vessel and were enrolled in a randomised trial of three endoscopic methods of haemostasis--adrenaline (1/10(4] alone, adrenaline plus polidocanol 1%, and adrenaline followed by yttrium-aluminium-garnet (YAG) laser photocoagulation. For patients with non-bleeding visible vessels sham treatment was significantly less effective in achieving haemostasis (8 of 20 patients) than were adrenaline plus polidocanol (18 of 20; p = 0.002) and adrenaline plus laser (16 of 20; p = 0.012). All three treatments significantly reduced total transfusion needs compared with sham treatment. For the whole group of patients, adrenaline plus polidocanol was significantly more effective than adrenaline alone in achieving permanent haemostasis; adrenaline plus laser was also more effective than adrenaline alone, but not significantly so. The efficacy of the three treatments was enhanced by repeated application on recurrence of bleeding. Since injection therapy with adrenaline and polidocanol was at least as effective as adrenaline plus laser therapy, it should be preferred over laser therapy because it is cheaper, easier to use, and perhaps also safer.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Combined Modality Therapy; Drug Therapy, Combination; Endoscopy; Epinephrine; Evaluation Studies as Topic; Female; Follow-Up Studies; Hemostatic Techniques; Humans; Laser Therapy; Light Coagulation; Male; Middle Aged; Peptic Ulcer; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Random Allocation; Recurrence

Topics: Drug Therapy, Combination; Epinephrine; Ethanol; Humans; Peptic Ulcer; Polidocanol; Polyethylene Glycols

By using the literature important facts of the spontaneous course of ulcer bleeding are presented. Patient groups with a high risk for early rebleeding are characterized. The indication for operation is discussed regarding intensity and activity of bleeding and endoscopic findings. The operative technique of haemostasis in duodenal and gastric ulcer is described. The own cases are analysed with special respect to endoscopic haemostasis.

Topics: Adult; Aged; Arteries; Duodenal Ulcer; Duodenum; Emergencies; Endoscopy; Humans; Laser Therapy; Ligation; Middle Aged; Peptic Ulcer; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Polidocanol; Polyethylene Glycols; Prognosis; Recurrence; Stomach Ulcer; Suture Techniques

In a prospective study a new therapeutic concept was tested on 76 patients with bleeding gastroduodenal ulcers. During emergency endoscopic an exact inspection of the ulcercrater helped to determine the possibility of recurrent bleeding of the ulcer. This possibility was expressed in a modified Forrest-classification. Endoscopic hemostasis has been performed in all cases of active bleeding. Ulcers with a big visible vessel stump should be operated early elective after an intervall of intensive care, because definitive endoscopic hemostasis seemed not to be sufficient with this bleeding type. The new concept decreased the operation frequency of bleeding gastroduodenal ulcers from 51% in 1981/82 to 34% in 1983. Mortality of bleeding duodenal ulcers decreased from 18% to 8,6%, in bleeding stomach ulcers from 24% to 18%. Endoscopic hemostasis with injection therapy has proved to be most successfull in the F1b bleeding type.

Topics: Aged; Combined Modality Therapy; Emergencies; Gastrectomy; Gastroscopy; Humans; Middle Aged; Peptic Ulcer; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prognosis; Recurrence; Therapeutic Irrigation