Epinephrine versus epinephrine plus fibrin glue injection in peptic ulcer bleeding: a prospective randomized trial
Détails
ID Serval
serval:BIB_2682F2A5764E
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Epinephrine versus epinephrine plus fibrin glue injection in peptic ulcer bleeding: a prospective randomized trial
Périodique
Gastrointestinal Endoscopy
ISSN
0016-5107 (Print)
Statut éditorial
Publié
Date de publication
03/2002
Volume
55
Numéro
3
Pages
348-53
Notes
Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't --- Old month value: Mar
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't --- Old month value: Mar
Résumé
BACKGROUND: Peptic ulcer bleeding remains a disease with considerable morbidity and mortality. Epinephrine is the most widely used endoscopic injection agent, but bleeding recurs in 20% of high-risk cases. Fibrin glue might be an ideal injection agent, based on its physiologic properties, despite its demanding injection technique and high cost. The aim of this study was to determine whether the injection of fibrin glue in combination with epinephrine improves outcome for patients at high risk of recurrent bleeding. METHODS: Patients were prospectively randomized to injection of epinephrine alone (n = 70) or epinephrine plus fibrin glue (n = 65). Endoscopy was repeated daily until the ulcer base was clean. All patients were treated with high-dose omeprazole. RESULTS: Initial hemostasis was 100% in both groups. There was no significant overall difference in rates of recurrent bleeding (24.3% and 21.5%, respectively, for epinephrine and epinephrine plus fibrin). When patients were stratified according to Forrest criteria, no significant difference could be found, although there was a trend toward less recurrent bleeding after fibrin injection of actively bleeding ulcers. There was no significant difference in the proportions of patients who required surgery (10% and 6%, respectively, for epinephrine and epinephrine plus fibrin). Mortality was the same (3%) in each group. CONCLUSIONS: Adding fibrin glue to epinephrine for injection treatment of bleeding peptic ulcers does not improve outcome. Fibrin glue might be of some value in selected cases.
Mots-clé
Adult
Aged
Aged, 80 and over
Combined Modality Therapy
Endoscopy, Gastrointestinal
Epinephrine/*therapeutic use
Female
Fibrin Tissue Adhesive/*therapeutic use
Hemostatics/*therapeutic use
Humans
Injections
Male
Middle Aged
Peptic Ulcer Hemorrhage/*drug therapy/pathology
Prospective Studies
Recurrence
Treatment Outcome
Vasoconstrictor Agents/*therapeutic use
Pubmed
Web of science
Création de la notice
25/01/2008 16:48
Dernière modification de la notice
20/08/2019 14:05