Effective therapy for peptic ulcer bleeding with a diagnostic scope: Design and preliminary results of a randomized trial comparing 7 fr injection gold probe with 10 FR heater probe

P. D. Stevens, J. Finegold, F. Van De Mierop, R. J. Garcia-Carrasquillo, T. H. Riley, P. H R Green, Frances Meyer, R. Rosenberg, S. K. Lewis, M. Rubin, L. Schneider, C. J. Lightdale

Research output: Contribution to journalArticle

Abstract

Purpose: To compare effectiveness of the 7 Fr injection gold probe (IGP) [Microvasive, MA] to that of the 10 Fr heater probe (HP) [Olympus, NY] for treating peptic ulcer hemorrhage. Methods: All patients presenting with acute upper GI bleeding (UGIB), who were seen by the GI rapid response bleeding team (GIRRT) were evaluated with emergent endoscopy within 12 hours of presentation. Informed consent was obtained prior to endoscopy. Patients with peptic ulcers that were actively bleeding or which demonstrated a nonbleeding visible vessel were randomized to one of two groups. Active bleeding was treated with epinephrine injection followed by thermal therapy with either 10 Fr HP (HP group) or 7 Fr IGP (IGP group) until bleeding stopped and the vessel was flattened. Patients with nonbleeding visible vessels were treated either with 10 Fr HP (HP group) or 7 Fr IGP (IGP group) until the vessel was flattened. For treatment induced active bleeding, epinephrine injection therapy was used; these patients remained classified as nonbleeding visible vessels for purposes of analysis. Repeat endoscopy was performed for rebleeding based on the following criteria: recurrence of heatemesis, bloody NG aspirate, melena, or hematochezia coupled with development of "unstable vital signs" (defined as SBP≤90, heart rate≥10 or orthostatic changes in BP of≥20 or heart rate≥20) or drop in hematocrit≥4% in 24 hours after stabilization. Results: During the study period from July 1996 until November 1996, 83 patients with acute UGIB were evaluated by the GIRRT. Thirty-nine patients were approached for entrance into the study (36 consents signed, 3 refused). At present, 8 patients have been randomized. Six patients had bleeding visible vessels and 2 had nonbleeding visible vessels. Primary hemostasis was achieved in all patients. Three patients have been randomized to 7 Fr IGP and five to 10 Fr HP. Rebleeding occurred in 3 patients, (2 with 7 FR IGP, 1 with HP). In these 3 patients, repeat endoscopic therapy with the same device type produced permanent hemostasis. There was one perforation with the 10 Fr HP and none with the 7 Fr IGP. There has been no mortality to date. Conclusions: Treatment of active bleeding and nonbleeding visible vessels is feasible with the 7 Fr IGP. This trial is continuing to assess outcomes.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume45
Issue number4
Publication statusPublished - 1997
Externally publishedYes

    Fingerprint

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Stevens, P. D., Finegold, J., Van De Mierop, F., Garcia-Carrasquillo, R. J., Riley, T. H., Green, P. H. R., ... Lightdale, C. J. (1997). Effective therapy for peptic ulcer bleeding with a diagnostic scope: Design and preliminary results of a randomized trial comparing 7 fr injection gold probe with 10 FR heater probe. Gastrointestinal Endoscopy, 45(4).