LJubicic Neven, Supanc Vladimir, Vrsalovic Mislav
Division of Digestive Diseases, Endoscopy Unit, Department of Internal Medicine, Sestre milosrdnice Clinical Hospital, Zagreb, Croatia.
Hepatogastroenterology. 2004 Mar-Apr;51(56):408-12.
BACKGROUND/AIMS: The use of hemostatic clips is conceptually attractive for achieving definitive hemostasis in peptic ulcer bleeding. There are only a few clinical trials comparing clipping with other endoscopic hemostatic methods. The aim of this study is to assess the efficacy and safety of endoscopic clipping with that of injection of polidocanol for hemostasis from actively (spurting or oozing) bleeding peptic ulcer.
61 patients with active (spurting or oozing) bleeding gastroduodenal ulcers were randomly assigned to one of two endoscopic treatments: injection therapy with polidocanol 1% (injected in 0.5-1.0 mL increments at three to five sites around the bleeding vessel to a total of 5 mL) (n=30), or endoscopic clipping using a clipping device and clips (n=31). All patients from the polidocanol group and 22 (68.8%) patients from the clipping group received pretreatment with epinephrine. Hemostatic rates, rebleeding rates, amounts of blood transfusion, and durations of hospital stay were analyzed.
The initial hemostatic rate was 96.8% in the clipping group, and 96.7% in the polidocanol group, respectively. Mean transfusion requirements, mean number of hospital days and percentage needing surgery were comparable in both groups. Recurrent bleeding rates were higher, although not statistically significant in the polidocanol group than in the clipping group (13.3% vs. 6.5%, respectively).
Our data suggest that injection therapy with polidocanol and endoscopic hemoclips seems to be equivalent for actively (spurting and oozing) bleeding peptic ulcer.
背景/目的：使用止血夹在实现消化性溃疡出血的确定性止血方面，从概念上讲很有吸引力。仅有少数临床试验比较了夹闭术与其他内镜止血方法。本研究的目的是评估内镜下夹闭术与聚多卡醇注射术对活动性（喷射性或渗血）出血性消化性溃疡止血的有效性和安全性。
61例患有活动性（喷射性或渗血）出血性胃十二指肠溃疡的患者被随机分配至两种内镜治疗方法之一：1%聚多卡醇注射治疗（在出血血管周围的三至五个部位以0.5 - 1.0 mL的增量注射，总量为5 mL）（n = 30），或使用夹闭装置和夹子进行内镜夹闭术（n = 31）。聚多卡醇组的所有患者和夹闭组的22例（68.8%）患者接受了肾上腺素预处理。分析止血率、再出血率、输血量和住院时间。
夹闭组的初始止血率为96.8%，聚多卡醇组为96.7%。两组的平均输血需求量、平均住院天数和需要手术的百分比相当。聚多卡醇组的再出血率高于夹闭组，尽管无统计学意义（分别为13.3%和6.5%）。
我们的数据表明，聚多卡醇注射治疗和内镜止血夹对于活动性（喷射性和渗血）出血性消化性溃疡似乎等效。
