polidocanol and Stomach-Ulcer

The current state of ulcer treatment in Germany was analysed in a prospective multi-centre study. It was based on 1139 consecutive patients admitted to the participating hospitals because of upper gastrointestinal bleeding. The source of the bleeding was identified by diagnostic endoscopy in 1075 patients (94%), from a gastric and/or duodenal ulcer in 546 of them (mean age 62 +/- 18 years). Using Forrest's classification, 4% of patients were in bleeding stage Ia, 17% in stage Ib, 16% stage IIa, 30% stage IIb and 33% stage III. An attempt to arrest bleeding through the endoscope was made in 233 patients (43%): more often with tissue-preserving substances (epinephrine +/- NaCl in 36%, fibrin glue +/- epinephrine in 24%) than with tissue-damaging procedures (epinephrine + polidocanol +/- NaCl in 26%, epinephrine + thermocoagulation in 7%). Primary haemostasis was achieved in 219 patients (94%). There was a total of 66 recurrences of bleeding (12%), but the rate was 18% after endoscopic haemostasis. 64 patients (12%) required operative intervention, including initial emergency operations. Severe complications (infections, organic failure) occurred in 82 patients (16%). 114 of the 546 patients were in the high risk group (older than 60 years; high amount of bleeding). Their bleeding recurrence and mortality rates (27 and 22%, respectively) were significantly higher (P < 0.01) than those of the total group. Overall mortality rate was 11% (58 patients). The mortality rate depended on the severity of initial bleeding (26% for Forrest group Ia). After recurrent bleeding the mortality rate was 34% with conservative and 33% with operative treatment. 7% of all deaths were the direct result of bleeding. The following factors prognostically closely correlated with mortality rate: age of patient (P < 0.01); haemoglobin < 8 g/dl on admission (P < 0.05); initial severity of bleeding (Forrest group I; P < 0.05); and recurrence of bleeding (P < 0.001).

Topics: Age Factors; Aged; Duodenal Ulcer; Duodenoscopy; Electrocoagulation; Epinephrine; Female; Fibrin Tissue Adhesive; Gastroscopy; Hemoglobins; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prognosis; Prospective Studies; Recurrence; Risk Factors; Sclerosing Solutions; Sclerotherapy; Severity of Illness Index; Stomach Ulcer

In this prospective, randomized trial, bleeding gastroduodenal ulcers in the Forrest I and II stages were treated endoscopically with injection of either fibrin glue or polidocanol. After exclusion of four patients for various reasons, 38 patients were treated with fibrin glue (mean: 5.4 ml) and 41 patients with polidocanol (mean: 12.1 ml) with control endoscopies routinely performed on days 1, 3, and 7 after treatment. The two groups were comparable with regard to age, sex, ulcer location and Forrest classification. Recurrent bleeding was observed in five cases in the fibrin group and in ten cases in the polidocanol group; three and two patients in the fibrin and polidocanol groups, respectively, had to undergo surgery. We conclude that fibrin glue injection is an effective method for the treatment of bleeding gastroduodenal ulcers.

Topics: Adult; Aged; Aged, 80 and over; Duodenal Ulcer; Endoscopy, Gastrointestinal; Female; Fibrin Tissue Adhesive; Hemostasis, Endoscopic; Humans; Injections, Intralesional; Male; Middle Aged; Peptic Ulcer Hemorrhage; Pilot Projects; Polidocanol; Polyethylene Glycols; Prospective Studies; Stomach Ulcer

Endoscopic injection therapy significantly reduces the risk of bleeding relapse in patients with digestive hemorrhage due to peptic ulcers associated with a visible vessel. Profound and sustained acid inhibition by proton pump inhibitors may generate optimal conditions for clotting and prevent bleeding relapse. Over a one-year period, 52 patients presenting with digestive hemorrhage, in whom emergency endoscopy showed a peptic ulcer with a non-bleeding visible vessel, were enrolled in a multicenter randomized study comparing oral omeprazole, 40 mg per day (n = 31) vs adrenaline (1:10,000) plus polidocanol (1%) injection associated with oral ranitidine 300 mg per day (n = 21). Rebleeding occurred in 15/52 (29%) patients: 8/31 (26%) in the omeprazole group with 6 major hemorrhages (19%), and in 7/21 (33%) in the injection group with 3 major hemorrhages (14%); the differences were not significant. No difference was observed between omeprazole and injection group in terms of volume of transfused blood (2.03 +/- 1.5 vs 3.1 +/- 0.9 blood units), need for hemostatic surgery (9.6% vs 14.3%), mortality (19.3% vs 14.3%) and mean hospital stay (11.5 days both groups). This study suggests that oral omeprazole, 40 mg per day, has an efficacy comparable to injection therapy in reducing the bleeding relapse from non bleeding peptic ulcers associated with visible vessel.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Drug Therapy, Combination; Duodenal Ulcer; Epinephrine; Female; Humans; Injections; Male; Middle Aged; Omeprazole; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Ranitidine; Recurrence; Stomach Ulcer

To date several agents have been used to achieve haemostasis in patients with non-variceal upper gastrointestinal bleeding using endoscopic sclerotherapy techniques. Polidocanol has been widely used but local complications have been reported after treatment. We have compared the efficacy and safety of thrombin and polidocanol in 82 consecutive patients with ongoing or recent bleeding from duodenal, gastric, or anastomotic ulcers. Primary control of haemostasis from spurting vessels was achieved in 90% of cases using polidocanol and in 86.6% using thrombin. Definitive haemostasis was obtained in 80% of patients in both groups. When a non-bleeding vessel was visible, injection of polidocanol or thrombin effectively prevented rebleeding in 90.9% and 85.7% of cases, respectively. When a non-bleeding sentinel clot was present, injection of polidocanol or thrombin provided definitive haemostasis in 100% and 92.8% of cases, respectively. No statistically significant difference was evident between the two agents. In the polidocanol group, one local haemorrhagic complication was noted. No general or local complications were recorded in the thrombin group.

Topics: Duodenal Ulcer; Endoscopy, Gastrointestinal; Female; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer; Thrombin

To evaluate the efficacy of three endoscopic methods which utilize different mechanisms of hemostasis to control bleeding peptic ulcers, we performed a prospective randomized study in 83 patients. Thirty-two patients were treated with 1:10000 adrenalin (Group I), 29 patients with 1:10000 adrenalin +1% aethoxysclerol (Group II), and 22 patients with the heater probe (Group III). Gastric ulcers were the source of bleeding in 14, 15 and 12 patients while duodenal ulcers were the source in 16, 13 and 10 patients in Groups I, II and III, respectively. Two stomal ulcers were noted in Group I and 1 in Group II. Two spurters were treated in Group I and 4 in Group II, while 22, 13 and 10 oozers were treated in Groups I, II and III, respectively. Definitive hemostasis was achieved in 94%, 100% and 95% in Groups I, II and III, respectively while the rebleeding rate was 6.25%, 6.9% and 9% respectively. 1:10000 adrenalin injection alone or when combined with subsequent instillation of a sclerosing agent and heater probe application have comparable efficacy in the endoscopic control of bleeding peptic ulcers.

Topics: Duodenal Ulcer; Endoscopy, Digestive System; Epinephrine; Hemostatic Techniques; Humans; Injections, Intralesional; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Stomach Ulcer

The present prospective randomized trial has been carried out to assess the efficacy of the endoscopic injection of epinephrine plus polidocanol, in the prompt treatment of upper gastrointestinal bleeding due to peptic lesions. Over a period of one year, 72 patients were admitted to the study. Thirty-six of these underwent endoscopic treatment (group A), while the others received medical treatment (group B). Definitive hemostasis was achieved in 29 patients in group A, and in 21 in group B (p less than 0.05). Seven patients in group A and 12 in group B underwent emergency surgery for persistent or recurrent bleeding (p = NS). Three patients from group B received endoscopic treatment owing to relative surgical contraindications. It was successful in all of them. Patients from group A needed a significantly lower number of units of packed red cells (p less than 0.05). Our results show that it is justified to employ endoscopic injection as the first therapeutic step in upper GI bleeding due to peptic gastroduodenal lesions.

Topics: Adult; Aged; Aged, 80 and over; Clinical Trials as Topic; Epinephrine; Gastroscopy; Hemostatic Techniques; Humans; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Random Allocation; Sclerosing Solutions; Stomach Ulcer

Of 113 patients in whom endoscopy revealed a bleeding gastric or duodenal ulcer 55 were randomly allocated to receive endoscopic sclerosis (ES) (injections of adrenaline/polidocanol) plus cimetidine while 58 received cimetidine alone as controls. 3 patients treated with ES (5.5%) compared with 25 controls (43.1%) had a major recurrent haemorrhage during their hospital stay. ES also led to significant reductions in the need for emergency surgery (3 vs 20 patients), transfusion requirements (mean 0.42 [SD 1.1] vs 2.7 (3.19) U), and the length of hospital stay (11.6 [5.1] vs 16.2 [11.3] days). ES as an adjunct to conventional medical treatment is an effective and safe emergency therapy for gastrointestinal bleeding due to peptic ulcer.

Topics: Adult; Aged; Cimetidine; Clinical Trials as Topic; Duodenal Ulcer; Endoscopy; Epinephrine; Humans; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Stomach Ulcer

To investigate treatment practice in non-variceal upper gastrointestinal bleeding (NVUGIB) caused by gastroduodenal ulcer and how it adheres to the best evidence as documented in randomized studies and meta-analyses.. The literature was surveyed to identify appropriate practices, and a structured multiple choice questionnaire developed and mailed to all departments in Denmark treating UGIB.. All 42 departments responded. All had therapeutic gastroscopes and equipment necessary for endoscopic haemostasis; 90% of departments had written guidelines. Adjuvant pharmacologic treatment included tranexamic acid in 38%. Proton-pump inhibitors (PPIs) were used by all departments, with 29% starting prior to endoscopic treatment. Eight departments (19%) used continuous PPI infusion, three of them starting with a bolus dose. In 50% of departments an anaesthesiologist was always present regardless of whether endotracheal intubation (routinely used by 10%) was used or not. Ten percent did not treat Forrest IIa and IIb ulcers, while IIc ulcers were treated by 36%. In 10% of departments clots were never removed, while in 2/3 attempts were made to remove resistant clots by mechanic means. Seven departments (17%) used monotherapy with epinephrine, while 59% always used dual therapy; 19% injected less than 10 ml. In rebleeding, 92% attempted endoscopic treatment before surgery, and used epinephrine in 79% of cases, while the remainder used epinephrine or polidocanol at the discretion of the endoscopist. Two out of three departments used high-dependency or intensive-care units for surveillance. Seventeen percent applied scheduled second-look gastroscopy.. Practice is variable, even in areas with established evidence based on randomized controlled studies, such as dosage and way of administration and duration of PPI treatment, injection treatment used as monotherapy and the volume used, including ulcers with clots for treatment, and the use of scheduled second-look endoscopy. Since the rebleeding rate has remained unchanged for decades, and rebleeding implies increased surgery and mortality rates, appropriate practices must be promoted in order to improve results. Development and implementation of national guidelines may facilitate the process.

Topics: Anesthetics; Antifibrinolytic Agents; Denmark; Drug Prescriptions; Duodenal Ulcer; Epinephrine; Evidence-Based Medicine; Gastrointestinal Agents; Gastroscopy; Hemostasis, Endoscopic; Humans; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Practice Guidelines as Topic; Practice Patterns, Physicians'; Proton Pump Inhibitors; Sclerosing Solutions; Stomach Ulcer; Surveys and Questionnaires; Sympathomimetics; Tranexamic Acid

The aims of this study were to identify risk factors for recurrence of hemorrhage in bleeding gastroduodenal ulcers after endoscopic injection therapy, and to develop a simple and relevant prognostic score which could be used to assess the early risk of recurrence and the residual risk of rebleeding.. A prospective study was conducted from January 1995 to December 1998, in 738 patients who were admitted to our department for acute bleeding peptic ulcer and who underwent endoscopic examination. Ulcers with active bleeding or signs of recent bleeding were treated with injection therapy using epinephrine (1/10,000) and 1% polidocanol.. Multivariate analysis revealed that liver cirrhosis, recent surgery, systolic blood pressure below 100 mmHg, hematemesis, Forrest classification, and ulcer size and site were significantly predictive variables for the recurrence of hemorrhage. Among these, Forrest classification was the most important. The overall accuracy of the predictive model was 71% (95% CI = 63 - 79%). The model showed a better sensitivity of 90% for early rebleeding (< 48 hours) than for late rebleeding (> or = 48 hours) where the sensitivity was 65 %. A prognostic score was obtained and patients were classified into four risk classes: very low (VL), low (L), high (H), and very high (VH). The rebleeding rates for the four classes were 0%, 7.9%, 31.8% and 67.9%, and the mortality rates were 5.9%, 8.6%, 13.9% and 35.7%, respectively. The residual risk of rebleeding after 48 hours was 0%, 3.3%, 10.4%, and 14.3% in the VL, L, H and VH classes, respectively. After 5 days the residual risk was under 4% in all classes.. This study demonstrates that the proposed prognostic score, which is easily obtained after emergency endoscopy, is useful in clinical practice because it can identify patients with different levels of rebleeding risk. It can be helpful in patient management and decision making for discharge.

Topics: Aged; Analysis of Variance; Blood Vessels; Duodenal Ulcer; Endoscopy, Gastrointestinal; Epinephrine; Female; Humans; Logistic Models; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prognosis; Recurrence; Risk Factors; Stomach; Stomach Ulcer; Tissue Adhesives; Vasoconstrictor Agents

The aim of this study was to investigate the efficacy of endoscopic injection therapy on the clinical outcome of elderly patients with peptic ulcer bleeding.. From January 1995 to December 1998, 738 patients with acute peptic ulcer bleeding were observed in the First Division of General Surgery, University of Verona: 359 aged <70 years and 379 =/>70 years. History, clinical and endoscopic findings and outcome were prospectively collected and analyzed comparing old (=/>70 yrs) and young (<70 yrs) patients. Ulcers with active or sign of recent bleeding were submitted to injection therapy using epinephrine and 1% polidocanol.. Coexisting diseases were significantly more present in the elderly group except for liver cirrhosis that affected preferentially young patients (12.3 versus 4.0%; p<0.001). Endoscopic treatment was performed in a similar percentage between young and elderly patients (respectively 64.9 e 61.5%) and also the rebleeding rate (14.2 versus 13.2) and the mean duration of hospitalisation were not different. The overall mortality was 12.7% in the elderly group and 8.3% in the young group (p=0.04), whereas mortality after surgery was significantly higher in the young group (respectively 57.1 versus 8.3%; p=0.037).. The clinical and endoscopic features and reebleeding rate were not different between elderly and young patients. Patients aged 70 years or older have a higher number of associated medical diseases except for liver cirrhosis conditions and a highest overall mortality whereas the risk of death after surgery is lower than in the younger group.

Topics: Acute Disease; Aged; Duodenal Ulcer; Epinephrine; Female; Humans; Male; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Stomach Ulcer

A 43-year-old man with a gastric ulcer was admitted because of sudden onset of epigastric pain, cold sweats and dizziness. He had tachycardia (100/min); his blood pressure was 120/80 mm Hg: his epigastrium was tender to palpation. There were no tarry stools.. Haemoglobin concentration was 12.7 g/dl. WBC count 17,900/microliter. Gastroscopy revealed residual haematin and an ulcer with an arterial stump at the angular fold.. 3 ml epinephrine, diluted 1:20,000, and 13 ml of 1% polidocanol were injected around the arterial stump, most of the latter solution flowing back into the gastric lumen from the rather hard ulcer base. Haematemesis four days later necessitated laparotomy followed by gastrectomy with reconstruction and a Roux-Y anastomosis because of complete necrosis of the gastric wall. Histological examination of the surgical specimen showed chronic scarred gastric ulcer and ulcerating pangastritis with haemorrhagic necrosis of the wall and associated peritonitis, caused by accidental injection of polidocanol into the artery.. Since the tissue-sparing injection of epinephrine, fibrin glue or salt solution is alone effective in the endoscopic treatment of bleeding gastroduodenal ulcers, polidocanol should not be injected as well.

Topics: Adult; Anastomosis, Roux-en-Y; Epinephrine; Gastrectomy; Gastroscopy; Hematemesis; Humans; Injections, Intralesional; Male; Necrosis; Peritonitis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach; Stomach Ulcer

The clinical histories of 14 patients with digestive hemorrhage due to Dieulafoy disease admitted to the authors' hospital over 74 months were retrospectively analyzed. These cases represent 1.18% of the non varicose upper digestive hemorrhages (CI 95%; 0.57-1.79%). Male predominance (6:1) and advanced age (median: 67.5 years) were observed. The ingestion of potentially gastroerosive drugs, smoking and alcoholism were reported in 57, 57 and 7% of the cases, respectively. Six patients (43%) required more than one endoscopy for diagnosis. The lesion responsible for hemorrhage was found at 6 cm or less from the cardias on 11 occasions (78%). Endoscopic sclerotherapy was performed in the vessel by polidocanol at 2% (1.5-10 ml, median: 6). In 10 cases sclerotherapy was preceded by the injection of adrenaline 1/10,000 (2-11 ml, median: 5). Definitive hemostasis was achieved in 11 patients (78%) (two of these cases required further sclerotherapy); 2 patients required surgery, and one patient (7%) died. Of the 13 surviving patients, none presented relapse after follow up of 2-63 months. We can conclude that Dieulafoy disease is an infrequent but severe cause of digestive hemorrhage, being predominantly found in males over the age of 50 years. Repeated endoscopy is often required to determine diagnosis and treatment. Endoscopic sclerotherapy with polidocanol is effective and safe in this disease although surgery may be required and death may occur.

Topics: Adult; Aged; Aged, 80 and over; Endoscopy; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Intestinal Mucosa; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer; Syndrome; Time Factors

Topics: Humans; Male; Middle Aged; Necrosis; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer

Although endoscopic injection therapy is effective in controlling initial haemorrhage from peptic ulcer, between 10% to 30% of patients suffer rebleeding.. To assess the factors that may predict the failure of endoscopic injection in patients bleeding from high risk gastric ulcer.. One hundred and seventy eight patients admitted for a gastric ulcer with a bleeding or a non-bleeding visible vessel were included.. Patients received endoscopic therapy by injection for adrenaline and polidocanol. Twelve clinical and endoscopic variables were entered into a multivariate logistic regression model to ascertain their significance as predictive factor of therapeutic failure.. Eighty seven per cent (155 of 178) of patients had no further bleeding after endoscopic therapy. Endoscopic injection failed in 23 (13%) patients: 20 (12%) continued to bleed or rebleed, and three (1%) patients could not be treated because of inaccessibility of the lesion. Logistic regression analysis showed that therapeutic failure was significantly related to: (1) the presence of hypovolaemic shock (p = 0.09, OR 2.38, 95% CI: 0.86, 6.56), (2) the presence of active bleeding at endoscopy (p = 0.02, OR 2.98, 95% CI: 1.12, 7.91), (3) ulcer location high on the lesser curvature (p = 0.04, OR 2.79, 95% CI: 1.01, 7.69), and (4) ulcer size larger than 2 cm (p = 0.01, OR 3.64, 95% CI: 1.34, 9.89).. These variables may enable identification of those patients bleeding from gastric ulcer who would not benefit from injection therapy.

Topics: Aged; Emergencies; Endoscopy, Gastrointestinal; Epinephrine; Female; Humans; Male; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Regression Analysis; Risk Factors; Sclerosing Solutions; Shock; Stomach Ulcer; Treatment Outcome; Vasoconstrictor Agents

In this study the frequency of rare causes of acute upper gastrointestinal bleeding was studied retrospectively using the case load of a large teaching hospital. Nine hundred and eighty patients with a clinical diagnosis of upper gastrointestinal bleeding were endoscoped between November 1987 and February 1993. Of these, 156 patients were found to be actively bleeding or had a visible vessel. Rare causes of bleeding were identified in 11 patients (7%). A Dieulafoy ulcer was found in five cases, and a mesenchymal tumor of the stomach in three patients. In the three remaining patients a bleeding gastric polyp, hemobilia and ischemic necrosis of the small bowel were identified as the source of bleeding. In three of these 11 patients the diagnosis was delayed and only made on repeat endoscopy the following day. Therapeutic endoscopy with circumlesional injection of epinephrine was successful in the majority of patients, and only three patients underwent emergency surgery. Two patients died during the acute bleeding episode, one of them had a Dieulafoy ulcer, the other suffered from ischemic bowel necrosis. Diagnosis of rare causes of acute upper gastrointestinal bleeding may be delayed, morbidity and mortality increased. Familiarity with these conditions may improve the outcome.

Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Duodenal Ulcer; Emergencies; Endoscopy, Digestive System; Epinephrine; Female; Gastrointestinal Hemorrhage; Humans; Male; Mallory-Weiss Syndrome; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Retrospective Studies; Stomach Ulcer; Survival Rate; Tissue Adhesives; Treatment Outcome

Bleeding non-neoplastic lesions of the upper gastrointestinal tract, not due to portal hypertension, are a frequent cause of emergency admission. In the present paper we report our retrospective experience in hemostatic injection treatment of these lesions. From May 1990 to May 1994, 164 patients were admitted to our institution for a bleeding gastrointestinal lesion. In 124 cases an ulcer classified according Forrest's criteria was detected. Four patients underwent immediate surgery. The second group of 86 patients (FIIa/FIIb/FIII) were treated conservatively. The third group of 34 patients (FIa/FIb/FIIa) underwent perilesional injection of adrenaline 1:10,000 and polidocanol 1% saline solution during endoscopic examination; 29% (25 pts) of the second group re-bled during the first 72 h vs 8.8% (3 pts) of the third group. The postoperative morbidity in the rebleeding patients was higher in the second group: 38.4% vs 0%. The importance of immediate, inexpensive, and simple hemostatic treatment extended to Forrest IIa lesions is emphasized.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Duodenal Ulcer; Epinephrine; Female; Gastritis; Gastroscopy; Hemostatic Techniques; Humans; Injections; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer

Topics: Drug Therapy, Combination; Duodenal Ulcer; Endoscopy, Gastrointestinal; Epinephrine; Ethanol; Humans; Injections; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Stomach Ulcer

Topics: Drug Therapy, Combination; Duodenal Ulcer; Endoscopy, Gastrointestinal; Epinephrine; Ethanol; Humans; Injections; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer

Endoscopic injection therapy was performed in a consecutive series of 233 patients admitted for a bleeding peptic ulcer with active arterial hemorrhage or a nonbleeding visible vessel disclosed at emergency endoscopy. Further bleeding occurred in 57 cases (24.5%). The present study was conducted to evaluate whether any clinical or endoscopic features could identify the patients at high risk of therapeutic failure. Multiple logistic regression analysis showed that failure was significantly related to: (1) the ulcer location on the posterior wall (P = 0.004) or superior wall (P = 0.003) of the duodenal bulb, (2) the ulcer size (P = 0.011), and (3) the existence of associated diseases (P = 0.012). The validity of the prediction rule based on these factors was evaluated by receiver-operating characteristic curves and was confirmed and prospectively validated in an independent sample of 81 patients with a bleeding peptic ulcer treated by endoscopic injection. We conclude that once the initial control of bleeding has been achieved by injection therapy, the present prediction rule can be used to identify candidates for alternative treatment.

Topics: Duodenal Ulcer; Epinephrine; Female; Hemostasis, Endoscopic; Humans; Logistic Models; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Risk Factors; ROC Curve; Sclerosing Solutions; Stomach Ulcer; Thrombin; Treatment Failure

Topics: Aged; Gastroscopy; Humans; Liver Abscess; Male; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerotherapy; Stomach Ulcer; Tomography, X-Ray Computed

A case is reported of progressive inner layer slough of the stomach antrum resulting in free perforation following endoscopic injection hemostasis of ulcer bleeding using a total of 5 ml polidocanol. This rare complication necessitated gastric resection. Relevant etiologic factors favoring this type of tissue response to endoscopic treatment are discussed.

Topics: Aged; Aged, 80 and over; Gastric Mucosa; Hemostasis, Endoscopic; Humans; Male; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Polidocanol; Polyethylene Glycols; Pyloric Antrum; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer

Endoscopic Doppler ultrasound enables the reliable identification of vessels in the base of gastroduodenal ulcers. In a prospective study including 114 patients with acute ulcer bleeding, pulsed Doppler ultrasound was able to demonstrate superficial blood vessels in the ulcer base in 62% of 106 cases where complete Doppler assessment was possible (93%). Agreement between the endoscopic pattern of visible vessels and the Doppler ultrasound findings was attained in only 52% of the cases. Doppler positive ulcers (n = 66) were treated with injection therapy (if necessary, repeated), irrespective of their Forrest classification. Using such an approach, the rebleeding rate in this group decreased to less than 8% and none of the patients died of causes related to the hemorrhage. All Doppler negative ulcers (n = 40) healed without complications or the need for endoscopic treatment; among these were 11 cases with Forrest IIa and b. We conclude that endoscopic Doppler appears to be a valuable diagnostic procedure in the assessment of bleeding ulcers, thus modifying the Forrest classification. Our concept is that Doppler positive ulcers require local endoscopic treatment, whereas Doppler negative ulcers can be treated conservatively.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Duodenal Ulcer; Endoscopy, Gastrointestinal; Hemostasis, Endoscopic; Humans; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Stomach Ulcer; Ultrasonography

Topics: Adult; Blood Flow Velocity; Carcinoma, Squamous Cell; Cardia; Esophageal and Gastric Varices; Esophageal Neoplasms; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemoperitoneum; Humans; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer; Ultrasonography

In this prospective study of 80 patients with active bleeding from the gastrointestinal tract a Doppler ultrasonographic investigation of the gastroduodenal ulcers was performed, in addition to immediate endoscopic examination. Admitted to this study were ulcers with the stigmata of acute bleeding, such as a visible blood vessel in the ulcer floor, a blood clot, or a black base and Forrest III lesions. In 52 patients Doppler ultrasonography was able to document unequivocally a superficial blood vessel. Complete agreement of endoscopic and Doppler results was obtained in only 49% of the cases. When a blood vessel was positively identified, local injection of epinephrine and polidocanol was carried out. Thereupon, in the further course, the acoustic signal was shifted into deeper regions or disappeared entirely. In 8% of the cases initial sclerosing was followed by a rebleed, which was again treated by injection therapy. None of the patients died of their GI hemorrhage. Endoscopic Doppler ultrasonography is a new and effective procedure that enables objectification of the endoscopic findings. It identifies the indication for proceeding to operative endoscopy and can monitor the effectiveness of the latter.

Topics: Adult; Aged; Aged, 80 and over; Duodenal Ulcer; Endoscopy, Gastrointestinal; Epinephrine; Female; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerotherapy; Stomach Ulcer; Ultrasonography

In 78 patients with high-risk bleeding peptic ulcers (either with active bleeding or non-bleeding visible vessel) endoscopic hemostasis by injection of adrenaline and polidocanol was attempted. Sclerotherapy was performed in 70 (90%) patients. Initial hemostasis was achieved in 35 (94.5%) patients with active bleeding, and permanent hemostasis in 61 (87%). Efficacy of injection therapy was significantly lower in ulcers larger than 2 cm (p = 0.001), and in those located on the posteroinferior duodenal wall (p = 0.03). It was not possible to perform endoscopic injection in 8 (10%) patients due to difficulty of access, lesions located mainly high on the lesser gastric curvature and on the posteroinferior duodenal wall. From these results we conclude that endoscopic injection is a very useful technique for the initial treatment of high-risk bleeding peptic ulcer, although the size and anatomical location of the lesions may be a limitation of its use.

Topics: Aged; Duodenal Ulcer; Duodenum; Endoscopy, Gastrointestinal; Epinephrine; Female; Hemostatic Techniques; Humans; Male; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach; Stomach Ulcer

Characteristics of the vascular course of ruptured vessels in the submucosal layer of Dieulafoy ulcer were studied, and endoscopic hemostatic treatment was performed using Aethoxysklerol and ethanol. 1) Observations of vessel courses in serial sections revealed that ruptured vessels in Dieulafoy ulcer exhibit rhexis in the lateral portions of the vessel and long courses over the ulcer margin in the submucous layer. 2) More dependable hemostasis seemed to be provided by thrombosis not only at the source of bleeding. i.e., at the site of vessel rupture, but also in the region of the whole ruptured vessel in the submucous layer. 3) Hemostatic treatment by local injection of Aethoxysklerol and ethanol was performed in 4 patients with Dieulafoy ulcer, and complete hemostasis was achieved in all 4 patients.

Topics: Adult; Aged; Drug Evaluation; Drug Therapy, Combination; Ethanol; Female; Gastroscopy; Hemostatics; Humans; Injections, Intralesional; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Stomach Ulcer

Emergency esophago-gastro-duodenoscopy was performed in 45 consecutive patients (26 men, 19 women, mean age 64 [23-91] years) with non-varicose upper gastrointestinal bleeding. The bleeding was arrested endoscopically by circumferential injection of an average of 6 (2-10) ml 1% polidocanol solution. In 10 patients an injection treatment was not possible because of extensive erosion or massive arterial bleeding. Bleeding recurred in seven patients 12-48 hours after initial injection. One patient in whom injection was not possible died during operation from massive intractable bleeding from an aortoduodenal fistula after abdominal aorta aneurysm surgery with implantation of a dacron prosthesis. There were no complications of the injection treatment.

Topics: Adult; Aged; Aged, 80 and over; Drug Evaluation; Duodenal Ulcer; Endoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Mallory-Weiss Syndrome; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Stomach Ulcer

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

Topics: Endoscopy; Epinephrine; Humans; Injections; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Stomach Ulcer

Besides the method of laser coagulation and electrocoagulation the endoscopic injection therapy of gastrointestinal bleeding in the stomach and in the duodenum seems to be a successful, inexpensive and simple method. In our hospital 62 pat. were treated by endoscopic injection therapy since 1978. A definitive hemostasis could be achieved in 83%, while the method did not succeed in 17% of patients.

Topics: Adult; Aged; Duodenal Ulcer; Duodenoscopy; Female; Gastroscopy; Humans; Injections; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Stomach Ulcer