RSS-Feed abonnieren
DOI: 10.1055/s-0034-1391565
Comparison of hemostatic forceps with soft coagulation versus argon plasma coagulation for bleeding peptic ulcer – a randomized trial
Publikationsverlauf
submitted 10. August 2014
accepted after revision 05. Januar 2015
Publikationsdatum:
02. März 2015 (online)
![](https://www.thieme-connect.de/media/endoscopy/201508/lookinside/thumbnails/146_10-1055-s-0034-1391565-1.jpg)
Background and study aims: Endoscopic high-frequency soft coagulation is used to manage visible bleeding or nonbleeding vessels during endoscopic submucosal dissection. The aim of the present study was to compare the efficacy of hemostasis by soft coagulation (using hemostatic forceps) with argon plasma coagulation (APC), in a prospective randomized trial.
Patients and methods: From January 2013 to June 2014, 276 patients were randomly assigned into two groups: epinephrine injection plus APC (the APC group); or epinephrine injection plus soft coagulation using hemostatic forceps (the HFSC group). As the primary outcome we compared recurrent bleeding rates within 30 days after initial hemostasis in a noninferiority design.
Results: After exclusion, 75 patients in the APC group and 76 in the HFSC group were finally evaluated. In the APC group 72 patients (96 %) were successfully treated with the assigned treatment alone vs. 73 (96 %) in the HFSC group. Initial endoscopic hemostasis using a single or combined modality was achieved in all patients. Recurrent bleeding within 30 days was experienced by five patients (6.7 %) and seven patients (9.2 %) in the AFC and HFSC groups, respectively (P = 0.563), and within 7 days by three patients (4.0 %) and five patients (6.6 %), respectively (P = 0.719). We found no significant difference in the rates of adverse events (1.3 % vs. 2.6 %) or mortality (2.7 % vs. 2.6 %) between the groups.
Conclusions: The efficacy and safety of soft coagulation using endoscopic hemostatic forceps is not inferior to APC when used to treat patients with bleeding peptic ulcers.
Clinicaltrials.gov NCT02020603.
-
References
- 1 Palmer K. Management of haematemesis and melaena. Postgrad Med J 2004; 80: 399-404
- 2 Rockall TA, Logan RF, Devlin HB et al. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995; 311: 222-226
- 3 Lau JY, Barkun A, Fan DM et al. Challenges in the management of acute peptic ulcer bleeding. Lancet 2013; 381: 2033-2043
- 4 Cook DJ, Guyatt GH, Salena BJ et al. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992; 102: 139-148
- 5 Sacks HS, Chalmers TC, Blum AL et al. Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. JAMA 1990; 264: 494-499
- 6 Cappell MS, Friedel D. Acute nonvariceal upper gastrointestinal bleeding: endoscopic diagnosis and therapy. Med Clin North Am 2008; 92: 511-550, vii-viii
- 7 Conway JD, Adler DG, Diehl DL et al. Endoscopic hemostatic devices. Gastrointest Endosc 2009; 69: 987-996
- 8 Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 2009; 7: 33-47 quiz 31–32
- 9 Sung JJ, Tsoi KK, Lai LH et al. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut 2007; 56: 1364-1373
- 10 Vargo JJ. Clinical applications of the argon plasma coagulator. Gastrointest Endosc 2004; 59: 81-88
- 11 Taghavi SA, Soleimani SM, Hosseini-Asl SM et al. Adrenaline injection plus argon plasma coagulation versus adrenaline injection plus hemoclips for treating high-risk bleeding peptic ulcers: a prospective, randomized trial. Can J Gastroenterol 2009; 23: 699-704
- 12 Chau CH, Siu WT, Law BK et al. Randomized controlled trial comparing epinephrine injection plus heat probe coagulation versus epinephrine injection plus argon plasma coagulation for bleeding peptic ulcers. Gastrointest Endosc 2003; 57: 455-461
- 13 Karaman A, Baskol M, Gursoy S et al. Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding. World J Gastroenterol 2011; 17: 4109-4112
- 14 Freeman ML. New and old methods for endoscopic control of nonvariceal upper gastrointestinal bleeding. Rev Gastroenterol Mex 2003; 68: 62-65
- 15 Takizawa K, Oda I, Gotoda T et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection--an analysis of risk factors. Endoscopy 2008; 40: 179-183
- 16 Kataoka M, Kawai T, Hayama Y et al. Comparison of hemostasis using bipolar hemostatic forceps with hemostasis by endoscopic hemoclipping for nonvariceal upper gastrointestinal bleeding in a prospective non-randomized trial. Surg Endosc 2013; 27: 3035-3038
- 17 Kataoka M, Kawai T, Yagi K et al. Clinical evaluation of emergency endoscopic hemostasis with bipolar forceps in nonvariceal upper gastrointestinal bleeding. Dig Endosc 2010; 22: 151-155
- 18 Fujishiro M, Abe N, Endo M et al. Retrospective multicenter study concerning electrocautery forceps with soft coagulation for nonmalignant gastroduodenal ulcer bleeding in Japan. Dig Endosc 2010; 22: 15-S18
- 19 Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974; 2: 394-397
- 20 Storey DW, Bown SG, Swain CP et al. Endoscopic prediction of recurrent bleeding in peptic ulcers. NEJM 1981; 305: 915-916
- 21 Arima S, Sakata Y, Ogata S et al. Evaluation of hemostasis with soft coagulation using endoscopic hemostatic forceps in comparison with metallic hemoclips for bleeding gastric ulcers: a prospective, randomized trial. J Gastroenterol 2010; 45: 501-505
- 22 Anderson MA, Ben-Menachem T, Gan SI et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 2009; 70: 1060-1070
- 23 Jang JY, Joo KR, Hwangbo Y et al. A comparison of the effect of high-dose oral and intravenous proton pump inhibitor on the prevention of rebleeding after endoscopic treatment of bleeding peptic ulcers. Korean J Gastrointest Endosc 2006; 33: 6-11
- 24 Kanai M, Hamada A, Endo Y et al. Efficacy of argon plasma coagulation in nonvariceal upper gastrointestinal bleeding. Endoscopy 2004; 36: 1085-1088
- 25 Wang HM, Hsu PI, Lo GH et al. Comparison of hemostatic efficacy for argon plasma coagulation and distilled water injection in treating high-risk bleeding ulcers. J Clin Gastroenterol 2009; 43: 941-945
- 26 Lau JY, Leung WK, Wu JC et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. NEJM 2007; 356: 1631-1640
- 27 Sung JJ, Suen BY, Wu JC et al. Effects of intravenous and oral esomeprazole in the prevention of recurrent bleeding from peptic ulcers after endoscopic therapy. Am J Gastroenterol 2014; 109: 1005-1010
- 28 Owens WD, Felts JA, Spitznagel EL et al. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978; 49: 239-243
- 29 Calvet X, Vergara M, Brullet E et al. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology 2004; 126: 441-450
- 30 Barkun AN, Martel M, Toubouti Y et al. Endoscopic hemostasis in peptic ulcer bleeding for patients with high-risk lesions: a series of meta-analyses. Gastrointest Endosc 2009; 69: 786-799
- 31 Marmo R, Rotondano G, Piscopo R et al. Dual therapy versus monotherapy in the endoscopic treatment of high-risk bleeding ulcers: a meta-analysis of controlled trials. Am J Gastroenterol 2007; 102: 279-289 quiz 469
- 32 Barkun AN, Bardou M, Kuipers EJ et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010; 152: 101-113
- 33 Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol 1994; 2: 42-46
- 34 Canard JM, Vedrenne B. Clinical application of argon plasma coagulation in gastrointestinal endoscopy: has the time come to replace the laser?. Endoscopy 2001; 33: 353-357
- 35 Cipolletta L, Bianco MA, Rotondano G et al. Prospective comparison of argon plasma coagulator and heater probe in the endoscopic treatment of major peptic ulcer bleeding. Gastrointest Endosc 1998; 48: 191-195
- 36 Havanond C, Havanond P. Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding. Cochrane Database Syst Rev 2005; CD003791
- 37 Enomoto S, Yahagi N, Fujishiro M et al. Novel endoscopic hemostasis technique for use during endoscopic submucosal dissection. Endoscopy 2007; 39: E156
- 38 Fujishiro M, Yahagi N, Nakamura M et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 2006; 63: 243-249
- 39 Nagata S, Kimura S, Ogoshi H et al. Endoscopic hemostasis of gastric ulcer bleeding by hemostatic forceps coagulation. Dig Endosc 2010; 22: S22-S25
- 40 Johnston JH, Jensen DM, Auth D. Experimental comparison of endoscopic yttrium-aluminum-garnet laser, electrosurgery, and heater probe for canine gut arterial coagulation. Importance of compression and avoidance of erosion. Gastroenterology 1987; 92: 1101-1108