Background and Aims

Although various methods are used in the treatment of peptic ulcer bleeding, there is not a standard recommended approach. The choice depends on multiple factors such as location of the ulcer, clinical experience of the endoscopist, and local facilities of the clinic. We aimed to compare the efficacy of monopolar hemostatic forceps soft coagulation (MHFSC) and hemoclips (HCs) in the treatment of peptic ulcer–related upper GI bleeding.

Methods

The study group included patients who had GI bleeding due to Forrest 1a, 1b, and 2a gastric or duodenal ulcers within 1 year. Patients with bleeding diathesis, history of gastrectomy, pregnancy, or younger than age 18 years were excluded. The remaining were randomized to MHFSC and HC treatment groups and compared in terms of clinical and endoscopic features, initial hemostasis success rates, recurrent bleeding rates within the first 7 days, time to achieve hemostasis, length of hospitalization stay, and adverse events.

Results

One hundred twelve patients were randomized to MHFSC (n = 56) and HC (n = 56) groups. There was no statistically significant difference between the groups with respect to demographic features, medications, underlying chronic diseases, location, and Forrest classification of the ulcers. The initial hemostasis success rate was 98.2% (55/56) in the MHFSC group and 80.4% (45/56) in the HC group (P = .004). Recurrent bleeding was detected in 2 patients in the MHFSC group (3.6%) and 8 patients in the HC group (17.7%; P = .04). The duration of endoscopic procedures (302 ± 87.8 vs 568 ± 140.4 seconds) and the length of hospital stay (3.50 ± 1.03 vs 4.37 ± 1.86 days) were significantly shorter in the MHFSC group. There were no adverse events in either group.

Conclusions

MHFSC is more effective in achieving initial hemostasis compared with HCs in the treatment of peptic ulcer bleeding and provides a shorter procedure time and a lower recurrent bleeding rate.

中文翻译：

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单极性止血钳与软凝止血钳和止血钳治疗消化性溃疡出血的比较：一项随机试验（视频）

背景和目标

尽管用于消化性溃疡出血的治疗方法多种多样，但尚无推荐的标准方法。选择取决于多种因素，例如溃疡的位置，内镜医师的临床经验以及诊所的当地设施。我们旨在比较单极止血钳软凝（MHFSC）和止血钳（HCs）在治疗消化性溃疡相关的上消化道出血中的疗效。

方法

研究组包括在1年内因Forrest 1a，1b和2a胃或十二指肠溃疡而发生GI出血的患者。排除具有出血性体质，胃切除术史，妊娠或年龄小于18岁的患者。其余患者被随机分为MHFSC和HC治疗组，并在临床和内窥镜检查特征，初始止血成功率，头7天内复发出血率，止血时间，住院时间和不良事件方面进行比较。

结果

112名患者被随机分为MHFSC组（n = 56）和HC组（n = 56）。在人口统计学特征，药物，潜在的慢性疾病，位置和溃疡的福雷斯特分类方面，各组之间在统计学上没有显着差异。MHFSC组的初始止血成功率为98.2％（55/56），HC组的初始止血成功率为80.4％（45/56）（P  = .004）。在MHFSC组中有2例（3.6％）复发性出血，在HC组中有8例（17.7％；P  = .04）。MHFSC组的内窥镜检查时间（302±87.8 vs 568±140.4秒）和住院时间（3.50±1.03 vs 4.37±1.86天）显着缩短。两组均无不良反应。

结论

与HCs相比，MHFSC在治疗消化性溃疡出血方面更有效地实现了初始止血，并且手术时间更短，复发出血率更低。