A major problem in the endoscopic management of acute UGIB is the presence of blood and clots overlying the bleeding source, preventing visualization of the lesion. Traditional attempts to overcome this problem by physical removal of blood have proven unsatisfactory. A simpler and near-ideal alternative is to alter the characteristics of blood such that it not only becomes easier to remove but also becomes translucent. We have shown that both these goals can be achieved by the novel use of 3% hydrogen peroxide (H2O2) in a prospective placebo controlled double blind trial of this agent in an experimental bleeding model (Am J Gastro 1996;91:1915 abs). We now report the results of an ongoing pilot study of H2O2 in patients with acute UGIB. Methods: Patients with UGIB were recruited into the study if the presence of blood or clots prevented visualization of the site of bleeding. The potential site of bleeding was initially sprayed with 75-100 mls of saline and then sprayed with 75-100mls of 3% H2O2 mixed with Mylicon. The following scoring system was used to evaluate the ability of the saline & peroxide to clear the blood and clots: 0=no change; 1=minimal clearing; 2=good clearance; 3=excellent clearance; Results: 5 patients (4M,1F; mean age = 72.2) with acute UGIB secondary to duodenal ulcer (n=3), gastric varices (n=1), Dieulafoy's lesion (n=1) were recruited. All patients who had H2O2 spray had good to excellent visualization of the bleeding source as compared to none who had saline spray (p=0.008). There was a significant improvement in the mean blood clearance score after H2O2 spray as compared to after saline spray (2.8 vs. 0.75; p=0.004). In 2 patients who were actively bleeding, the H2O2 appeared to also result in hemostasis. There were no adverse effects or complications. Conclusions: H2O2 significantly enhanced clot dissolution and endoscopic visualization in patients with acute UGIB.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging