Soon Maw-Soan, Wu Shun-Sheng, Chen Yang-Yuan, Fan Chuan-Sang, Lin Otto S
Department of Gastroenterology, ChangHua Christian Medical Center, Taiwan, ROC.
Gastrointest Endosc. 2003 Sep;58(3):323-9.
Severe upper GI hemorrhage from an actively bleeding peptic ulcer is sometimes difficult to treat by conventional endoscopic means, such as multipolar electrocoagulation, heat probe coagulation, and injection therapy. It was hypothesized that monopolar coagulation with a "hot biopsy" forceps may be more effective in such cases.
A prospective, randomized trial was performed to assess the safety and short-term efficacy of monopolar coagulation versus conventional treatment (combination heat probe coagulation and injection therapy) in the treatment of patients with various types of actively bleeding or high-risk ulcers.
Primary hemostasis was achieved in 54 of 56 actively bleeding patients in the monopolar coagulation group. In contrast, primary hemostasis was achieved in 33 of 43 patients in the control group (p = 0.003), with 8 of the remaining 10 being treated successfully by crossover monopolar coagulation. During 30-day follow-up, bleeding recurred in 6 patients in the conventional therapy group versus none in the monopolar coagulation group (p = 0.012). Post-endoscopy blood transfusion requirements were lower in the monopolar coagulation group. Mortality and surgery rates were zero in both groups. There was no procedure-related complication.
This study demonstrated improved primary hemostasis and a reduced short-term rate of recurrent bleeding for patients with actively bleeding and high-risk non-bleeding peptic ulcers treated by monopolar coagulation. The complication rate associated with monopolar coagulation was low.
活动性出血的消化性溃疡所致严重上消化道出血有时难以通过常规内镜手段治疗，如多极电凝、热探头凝固和注射治疗。据推测，使用“热活检”钳进行单极凝固在这类病例中可能更有效。
进行了一项前瞻性随机试验，以评估单极凝固与传统治疗（热探头凝固和注射治疗联合）在治疗各类活动性出血或高危溃疡患者中的安全性和短期疗效。
单极凝固组56例活动性出血患者中有54例实现了初步止血。相比之下，对照组43例患者中有33例实现了初步止血（p = 0.003），其余10例中有8例通过交叉单极凝固成功治疗。在30天随访期间，传统治疗组有6例患者再次出血，而单极凝固组无再次出血病例（p = 0.012）。单极凝固组内镜检查后的输血需求较低。两组的死亡率和手术率均为零。没有与操作相关的并发症。
本研究表明，对于接受单极凝固治疗的活动性出血和高危非出血性消化性溃疡患者，初步止血效果更好，短期再出血率降低。与单极凝固相关的并发症发生率较低。
