Multipolar electrocoagulation in the treatment of peptic ulcers with nonbleeding visible vessels. A prospective, controlled trial.

STUDY OBJECTIVE

To assess the efficacy and safety of treatment with endoscopic multipolar electrocoagulation in patients who have ulcers with nonbleeding visible vessels.

DESIGN

Prospective, randomized, sham-controlled trial; patients were followed until their discharge from the hospital.

SETTING

Urban, nonreferral county hospital.

PATIENTS

Consecutive sample of 75 patients who had a bloody nasogastric aspirate sample, melena, or hematochezia; unstable vital signs, a transfusion of at least two units of blood in 12 hours, or a drop in the hematocrit of at least 0.06 in 12 hours; and endoscopic evidence of an ulcer with a nonbleeding visible vessel.

INTERVENTION

Sham or real multipolar electrocoagulation at the time of diagnostic endoscopy.

MEASUREMENTS AND MAIN RESULTS

Compared with the control group, the group receiving multipolar electrocoagulation showed marked improvement in the following variables; rebleeding (18% compared with 41%, P less than 0.05; difference, 23%; 95% CI, 3% to 43%); need for emergency surgery (8% compared with 30%, P less than 0.05; difference, 22%; CI, 5% to 39%); mean number of hospital days (4.3 +/- 0.4 compared with 6.2 +/- 0.7, P less than 0.05; difference, 1.9; CI, 0.4 to 3.4); and cost of hospitalization ($3790 +/- $410 compared with $5730 +/- $650, P less than 0.05; difference, $1940; CI, $400 to $3480). The mean transfusion requirement in the treatment group was 1.6 +/- 0.3 as compared with 3.0 +/- 0.6 units in the control group (P = 0.13; difference, 1.4; CI, 0 to 2.8). The overall mortality was extremely low: Only 1 (1%) of 75 patients died. Bleeding was induced in 7 (18%) of the 38 patients treated with electrocoagulation, and 1 patient required urgent surgery.

CONCLUSIONS

Endoscopic treatment with multipolar electrocoagulation is beneficial in patients who present with major upper gastrointestinal hemorrhage and are found to have an ulcer with a nonbleeding visible vessel.