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Erschienen in: Journal of Gastroenterology 5/2010

01.05.2010 | Original Article—Alimentary Tract

Evaluation of hemostasis with soft coagulation using endoscopic hemostatic forceps in comparison with metallic hemoclips for bleeding gastric ulcers: a prospective, randomized trial

verfasst von: Seiichiro Arima, Yasuhisa Sakata, Shinichi Ogata, Naoyuki Tominaga, Nanae Tsuruoka, Kotaro Mannen, Ryosuke Shiraishi, Ryo Shimoda, Seiji Tsunada, Hiroyuki Sakata, Ryuichi Iwakiri, Kazuma Fujimoto

Erschienen in: Journal of Gastroenterology | Ausgabe 5/2010

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Abstract

Background

Endoscopic high-frequency soft coagulation, recently developed in Japan, is available for the management of gastric bleeding in cases of bleeding gastric ulcers and bleeding during endoscopic submucosal dissection. The aim of this study was to evaluate the efficacy of hemostasis with soft coagulation for bleeding gastric ulcers by comparing it with hemoclips in a prospective, randomized trial.

Methods

During the period of April 2006 to March 2008, 96 patients that had gastric ulcers with bleeding or nonbleeding visible vessels were enrolled in this study. All of the 96 patients were randomly divided into two groups: endoscopic hemostasis with soft coagulation (Group I) or endoscopic hemoclipping (Group II).

Results

A total of 41 (85%) out of 48 patients in Group I and 38 (79%) out of 48 patients in Group II were successfully treated with soft coagulation or clipping alone, respectively. The endoscopic hemostasis rate for the initial modality in combination with another endoscopic procedure performed after the initial method was 98% in both groups. One patient in Group I (2%) and five patients in Group II (10%) experienced recurrent bleeding. The time required to achieve hemostasis was shorter in Group I compared with Group II (9.2 ± 11.1 vs. 13.6 ± 9.4 min; P < 0.05).

Conclusions

This study revealed that soft coagulation is as effective as hemoclipping for treating bleeding gastric ulcers. The time required to achieve hemostasis was shorter with the soft coagulation procedure.
Literatur
1.
Zurück zum Zitat Marshall BJ, Warren JR. Unidentified curved bacilli in the stomachs of patients with gastritis and peptic ulceration. Lancet. 1984;1:1311–4.CrossRefPubMed Marshall BJ, Warren JR. Unidentified curved bacilli in the stomachs of patients with gastritis and peptic ulceration. Lancet. 1984;1:1311–4.CrossRefPubMed
2.
Zurück zum Zitat Schubert TT, Bologna SD, Nensey Y, Schubert AB, Mascha EJ, Ma CK. Ulcer risk factors, interactions between Helicobacter pylori infection, non-steroidal use, and age. Am J Med. 1993;94:413–8.CrossRefPubMed Schubert TT, Bologna SD, Nensey Y, Schubert AB, Mascha EJ, Ma CK. Ulcer risk factors, interactions between Helicobacter pylori infection, non-steroidal use, and age. Am J Med. 1993;94:413–8.CrossRefPubMed
3.
Zurück zum Zitat Hentschel E, Brandstatter G, Dragosics B, Hirschl AM, Nemec H, Schütze K, et al. Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer. N Engl J Med. 1993;328:308–12.CrossRefPubMed Hentschel E, Brandstatter G, Dragosics B, Hirschl AM, Nemec H, Schütze K, et al. Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer. N Engl J Med. 1993;328:308–12.CrossRefPubMed
4.
Zurück zum Zitat Labenz J, Borsch G. Evidence for the essential role of Helicobacter pylori in gastric ulcer disease. Gut. 1994;35:19–22.CrossRefPubMed Labenz J, Borsch G. Evidence for the essential role of Helicobacter pylori in gastric ulcer disease. Gut. 1994;35:19–22.CrossRefPubMed
5.
Zurück zum Zitat Van der Hulst RW, Rauws EA, Koycu B, Keller JJ, Bruno MJ, Tijssen JG, et al. Prevention of ulcer recurrence after eradication of Helicobacter pylori: a prospective long-term follow-up study. Gastroenterology. 1997;113:1082–6.CrossRefPubMed Van der Hulst RW, Rauws EA, Koycu B, Keller JJ, Bruno MJ, Tijssen JG, et al. Prevention of ulcer recurrence after eradication of Helicobacter pylori: a prospective long-term follow-up study. Gastroenterology. 1997;113:1082–6.CrossRefPubMed
6.
Zurück zum Zitat Kikkawa A, Iwakiri R, Ootani H, Ootani A, Fujise T, Sakata Y, et al. Prevention of the rehaemorrhage of bleeding peptic ulcer: effects of Helicobacter pylori eradication and acid suppression. Aliment Pharmacol Ther. 2005;21:79–84.CrossRefPubMed Kikkawa A, Iwakiri R, Ootani H, Ootani A, Fujise T, Sakata Y, et al. Prevention of the rehaemorrhage of bleeding peptic ulcer: effects of Helicobacter pylori eradication and acid suppression. Aliment Pharmacol Ther. 2005;21:79–84.CrossRefPubMed
7.
Zurück zum Zitat British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal hemorrhage: guidelines. Gut. 2002;51:41–6.CrossRef British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal hemorrhage: guidelines. Gut. 2002;51:41–6.CrossRef
8.
Zurück zum Zitat Koyama T, Fujimoto K, Iwakiri R, Sakata H, Sakata Y, Yamaoka K, et al. Prevention of recurrent bleeding from gastric ulcer with a nonbleeding visible vessel by endoscopic injection of absolute ethanol: a prospective, controlled trial. Gastrointest Endosc. 1995;42:128–31.CrossRefPubMed Koyama T, Fujimoto K, Iwakiri R, Sakata H, Sakata Y, Yamaoka K, et al. Prevention of recurrent bleeding from gastric ulcer with a nonbleeding visible vessel by endoscopic injection of absolute ethanol: a prospective, controlled trial. Gastrointest Endosc. 1995;42:128–31.CrossRefPubMed
9.
Zurück zum Zitat Ootani H, Iwakiri R, Shimoda R, Nakahara S, Amemori S, Fujise T, et al. Role of Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use in bleeding gastric ulcers in Japan. J Gastroenterol. 2006;41:41–6.CrossRefPubMed Ootani H, Iwakiri R, Shimoda R, Nakahara S, Amemori S, Fujise T, et al. Role of Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use in bleeding gastric ulcers in Japan. J Gastroenterol. 2006;41:41–6.CrossRefPubMed
10.
Zurück zum Zitat Raju GS, Kaltenbach T, Soetikno R. Endoscopic mechanical hemostasis of GI arterial bleeding. Gastrointest Endosc. 2007;66:774–85.CrossRefPubMed Raju GS, Kaltenbach T, Soetikno R. Endoscopic mechanical hemostasis of GI arterial bleeding. Gastrointest Endosc. 2007;66:774–85.CrossRefPubMed
11.
12.
Zurück zum Zitat Yamaguchi M, Iwakiri R, Yamaguchi K, Mizuta T, Shimoda R, et al. Bleeding and stenosis caused by reflux esophagitis was not common in emergency endoscopic examination: a retrospective patient chart review at a single institution in Japan. J Gastroenterol. 2008;43:265–9.CrossRefPubMed Yamaguchi M, Iwakiri R, Yamaguchi K, Mizuta T, Shimoda R, et al. Bleeding and stenosis caused by reflux esophagitis was not common in emergency endoscopic examination: a retrospective patient chart review at a single institution in Japan. J Gastroenterol. 2008;43:265–9.CrossRefPubMed
13.
Zurück zum Zitat Shimoda R, Iwakiri R, Sakata H, Ogata S, Ootani H, Sakata Y, et al. Endoscopic hemostasis with metallic hemoclips for iatrogenic Malloy–Weiss tear caused by endoscopic examination. Dig Endosc. 2009;21:20–3. Shimoda R, Iwakiri R, Sakata H, Ogata S, Ootani H, Sakata Y, et al. Endoscopic hemostasis with metallic hemoclips for iatrogenic Malloy–Weiss tear caused by endoscopic examination. Dig Endosc. 2009;21:20–3.
14.
Zurück zum Zitat Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection—an analysis of risk factors. Endoscopy. 2008;40:179–83. Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection—an analysis of risk factors. Endoscopy. 2008;40:179–83.
15.
Zurück zum Zitat Storey DW, Bowed SG, Swain CP, Salmon PR, Kirkham JS, Northfield TC. Endoscopic prediction of recurrent bleeding in peptic ulcers. N Eng J Med. 1981;305:915–6.CrossRef Storey DW, Bowed SG, Swain CP, Salmon PR, Kirkham JS, Northfield TC. Endoscopic prediction of recurrent bleeding in peptic ulcers. N Eng J Med. 1981;305:915–6.CrossRef
16.
Zurück zum Zitat Jensen DM. Spots and clots-leave them or treat them? Why and how to treat. Can J Gastroenterol. 1999;13:413–5.PubMed Jensen DM. Spots and clots-leave them or treat them? Why and how to treat. Can J Gastroenterol. 1999;13:413–5.PubMed
17.
Zurück zum Zitat Sugiyama T, Dozaiku T, Toyonaga T, Hirooka T, Ueda C, Iwata Y, et al. The usefulness of 4 + 1 contact method using soft coagulation for bleeding gastric ulcers (in Japanese with English abstract). Gastroenterol Endosc. 2006;48:204–11. Sugiyama T, Dozaiku T, Toyonaga T, Hirooka T, Ueda C, Iwata Y, et al. The usefulness of 4 + 1 contact method using soft coagulation for bleeding gastric ulcers (in Japanese with English abstract). Gastroenterol Endosc. 2006;48:204–11.
18.
Zurück zum Zitat Nagayama K, Tazawa J, Sakai Y, Miyasaka Y, Yu SH, Sakuma I, et al. Efficacy of endoscopic clipping for bleeding gastroduodenal ulcer: comparison with topical ethanol injection. Am J Gastroenterol. 1999;94:2897–901.CrossRefPubMed Nagayama K, Tazawa J, Sakai Y, Miyasaka Y, Yu SH, Sakuma I, et al. Efficacy of endoscopic clipping for bleeding gastroduodenal ulcer: comparison with topical ethanol injection. Am J Gastroenterol. 1999;94:2897–901.CrossRefPubMed
19.
Zurück zum Zitat Chung IK, Ham JS, Kim HS, Park SH, Lee MH, Kim SJ. Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc. 1999;49:13–8.CrossRefPubMed Chung IK, Ham JS, Kim HS, Park SH, Lee MH, Kim SJ. Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc. 1999;49:13–8.CrossRefPubMed
20.
Zurück zum Zitat Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, et al. Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointest Endosc. 2001;53:147–51.CrossRefPubMed Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, et al. Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointest Endosc. 2001;53:147–51.CrossRefPubMed
21.
Zurück zum Zitat Waring JP, Sanowski RA, Sawyer RL, Woods CA, Foutch PG. A randomized comparison of multipolar electrocoagulation and injection sclerosis for the treatment of bleeding peptic ulcer. Gastrointest Endosc. 1991;37:295–8.CrossRefPubMed Waring JP, Sanowski RA, Sawyer RL, Woods CA, Foutch PG. A randomized comparison of multipolar electrocoagulation and injection sclerosis for the treatment of bleeding peptic ulcer. Gastrointest Endosc. 1991;37:295–8.CrossRefPubMed
22.
Zurück zum Zitat Lin HJ, Chan CY, Lee FY, Huang ZC, Lee CH, Lee SD. Endoscopic injection to arrest peptic ulcer hemorrhage: a prospective, randomized controlled trial; preliminary results. Hepatogastroenterology. 1991;38:291–4.PubMed Lin HJ, Chan CY, Lee FY, Huang ZC, Lee CH, Lee SD. Endoscopic injection to arrest peptic ulcer hemorrhage: a prospective, randomized controlled trial; preliminary results. Hepatogastroenterology. 1991;38:291–4.PubMed
23.
Zurück zum Zitat Loren L. Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers. A prospective, randomized trial. Gastroenterology. 1990;99:1303–6. Loren L. Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers. A prospective, randomized trial. Gastroenterology. 1990;99:1303–6.
24.
Zurück zum Zitat Chung SCS, Leong HT, Chan ACW, Lau JY, Yung MY, Leung JW, et al. Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial. Gastrointest Endosc. 1996;43:591–5.CrossRefPubMed Chung SCS, Leong HT, Chan ACW, Lau JY, Yung MY, Leung JW, et al. Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial. Gastrointest Endosc. 1996;43:591–5.CrossRefPubMed
25.
Zurück zum Zitat Gralnek IM, Jensen DM, Gornbein J, Kovacs TO, Jutabha R, Freeman ML, et al. Clinical and economic outcomes of individuals with severe peptic ulcer hemorrhage and nonbleeding visible vessel: an analysis of two prospective clinical trials. Am J Gastroenterol. 1998;93:2009–11.CrossRef Gralnek IM, Jensen DM, Gornbein J, Kovacs TO, Jutabha R, Freeman ML, et al. Clinical and economic outcomes of individuals with severe peptic ulcer hemorrhage and nonbleeding visible vessel: an analysis of two prospective clinical trials. Am J Gastroenterol. 1998;93:2009–11.CrossRef
26.
Zurück zum Zitat Sung JJ, Tsoi KK, Lai LH, Wu JC, Lau JY. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut. 2007;56:1364–73.CrossRefPubMed Sung JJ, Tsoi KK, Lai LH, Wu JC, Lau JY. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut. 2007;56:1364–73.CrossRefPubMed
27.
Zurück zum Zitat Skok P, Krizman I, Skok M. Argon plasma coagulation versus injection sclerotherapy in peptic ulcer hemorrhage—a prospective, controlled study. Hepatogastroenterology. 2004;51:165–70. Skok P, Krizman I, Skok M. Argon plasma coagulation versus injection sclerotherapy in peptic ulcer hemorrhage—a prospective, controlled study. Hepatogastroenterology. 2004;51:165–70.
28.
Zurück zum Zitat Kanai M, Hamada A, Endo Y, Takeda Y, Yamakawa M, Nishikawa H, et al. Efficacy of argon plasma coagulation in nonvariceal upper gastrointestinal bleeding. Endoscopy. 2004;36:1085–8.CrossRefPubMed Kanai M, Hamada A, Endo Y, Takeda Y, Yamakawa M, Nishikawa H, et al. Efficacy of argon plasma coagulation in nonvariceal upper gastrointestinal bleeding. Endoscopy. 2004;36:1085–8.CrossRefPubMed
29.
Zurück zum Zitat Andriulli A, Annese V, Caruso N, et al. Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta-analyses. Am J Gastroenterol. 2005;100:207–19.CrossRefPubMed Andriulli A, Annese V, Caruso N, et al. Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta-analyses. Am J Gastroenterol. 2005;100:207–19.CrossRefPubMed
30.
Zurück zum Zitat Yuan Y, Wang C, Hunt RH, Pilotto A, Accadia L, Niro AG, et al. Endoscopic clipping for acute nonvariceal upper-GI bleeding: a meta-analysis and critical appraisal of randomized controlled trials. Gastrointest Endosc. 2008;68:339–51.CrossRefPubMed Yuan Y, Wang C, Hunt RH, Pilotto A, Accadia L, Niro AG, et al. Endoscopic clipping for acute nonvariceal upper-GI bleeding: a meta-analysis and critical appraisal of randomized controlled trials. Gastrointest Endosc. 2008;68:339–51.CrossRefPubMed
31.
Zurück zum Zitat Shimoda R, Iwakiri R, Sakata H, Ogata S, Kikkawa A, Ootani H, et al. Evaluation of endoscopic hemostasis with metallic hemoclips for bleeding gastric ulcer: comparison with endoscopic injection of absolute ethanol in a prospective, randomized study. Am J Gastroenterol. 2003;98:2198–202.CrossRefPubMed Shimoda R, Iwakiri R, Sakata H, Ogata S, Kikkawa A, Ootani H, et al. Evaluation of endoscopic hemostasis with metallic hemoclips for bleeding gastric ulcer: comparison with endoscopic injection of absolute ethanol in a prospective, randomized study. Am J Gastroenterol. 2003;98:2198–202.CrossRefPubMed
32.
33.
Zurück zum Zitat Gever AM, DeGoede E, Simoens M, Hiele M, Rutgeerts P. A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc. 2002;55:466–9.CrossRef Gever AM, DeGoede E, Simoens M, Hiele M, Rutgeerts P. A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc. 2002;55:466–9.CrossRef
34.
Zurück zum Zitat Nakayama M, Iwakiri R, Hara M, Ootani H, Shimoda R, Tsunada S, et al. Low-dose aspirin is a prominent cause of bleeding ulcers in patients who underwent emergency endoscopy. J Gastroenterol. 2009;44:912–8.CrossRefPubMed Nakayama M, Iwakiri R, Hara M, Ootani H, Shimoda R, Tsunada S, et al. Low-dose aspirin is a prominent cause of bleeding ulcers in patients who underwent emergency endoscopy. J Gastroenterol. 2009;44:912–8.CrossRefPubMed
Metadaten
Titel
Evaluation of hemostasis with soft coagulation using endoscopic hemostatic forceps in comparison with metallic hemoclips for bleeding gastric ulcers: a prospective, randomized trial
verfasst von
Seiichiro Arima
Yasuhisa Sakata
Shinichi Ogata
Naoyuki Tominaga
Nanae Tsuruoka
Kotaro Mannen
Ryosuke Shiraishi
Ryo Shimoda
Seiji Tsunada
Hiroyuki Sakata
Ryuichi Iwakiri
Kazuma Fujimoto
Publikationsdatum
01.05.2010
Verlag
Springer Japan
Erschienen in
Journal of Gastroenterology / Ausgabe 5/2010
Print ISSN: 0944-1174
Elektronische ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-009-0186-8

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