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13.
Peptic ulcer hemorrhage: Argon plasma coagulation versus injection sclerotherapy : a prospective, randomized, controlled study
Skok, Pavel ...
Introduction: peptic ulcer is the most common cause of acute upper digestive tract hemorrhage. Study aims: To evaluate the efficacy of argon plasma coagulation and injection sclerotherapy (IS) in ...bleeding peptic ulcer in a prospective, controlled, randomized study. Patients and methods: the study includes 80 patients with peptic ulcer hemorrhage (male 50, female 30, av. age 57,5 years, SDM 16, span 28-80; gastric ulcer 40 patients, duodenal ulcer 40 patients) in the period between 1.01 1999 and 1.03 2000. The bleeding activity was determined according to Forrest classification. Fourty patients (group A) were randomized to receive argon plasma coagulation and in fourty patients (group B) injection sclerotherapy (sclerosing with diluted adrenalin 1 : 10,000 plus polidocanol 1%) was performed. The groups did not differ with respect to age, sex, site, severity of bleeding, use of NSAID and additional diseases. Results: clinically and endoscopically diagnosed rebleeding occured in 7/40 patients (17.5%) in group A and 9/40 patients (22.5%) in group B. The majority og rebleeding occured within 48 hours after endoscopic hemostasis, group A 3/6 (50%), group B 6/9 (66.6%). Repeated endoscopic hemostasis did not prove successful in 7 patients (group A 3/40, 7.5%, group B 4/40, 10%). Six patients were treated operatively. The total mortality rate was 10% (8/80 patients, group A 3/40, 7.5%, group B 5/40, 12.5%). Only one patient died from gastrointestinal bleeding, other 7 patients died due to concomitant diseases. Conclusions: argon plasma coagulation is a promising method of endoscopic hemostasis. This procedure seems to be an effective alternative to other hemostatic modalities in peptic ulcer hemorrhage.
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