Comparation of endoscopic dual versus monotherapy in patients with high-risk bleeding ulcers: a retrospective trial

Giriş. Peptik ülser kanamaları potansiyel olarak hayatı tehdit eden ve sık kaşılaşılan bir tıbbi acildurumdur. Endoskopik tedaviler peptik ülser kanamasına bağlı morbidite ve mortaliteyi azaltır. Buçalışmada çiftli ve tekli endoskopik tedavilerin, aktif kanayan ülserli hastalarda, kanama tekrarı,cerrahi gereklilik ve kanamaya bağlı ölüm üzerine tedavi etkinliğinin karşılaştırılmasıamaçlanmıştır. Yöntem. Akdeniz Üniversitesi Hastanesi Endoskopi Ünitesine başvuran,endoskopilerinde aktif kanama veya yüksek riskli ülsere sahip 125 hastanın verileri retrospektifolarak değerlendirildi. 43 hastaya yalnızca epinefrin enjeksiyon tedavisi ve 33 hastaya epinefrin veheater probe tedavisi uygulandı. 29 hastaya gold probe ve epinefrin enjeksiyon tedavisi ve 20hastaya sadece heater probe tedavisi uygulandı. Bulgular. Tedavi gruplarında başlangıç hemostazoranları, sadece epinephrine enjeksiyonunda 39/43 (%81,7), epinefrin heater probekombinasyonunda 33/33 hasta da (%100), epinefrin enjeksiyonu ve gold probe kombinasyonunda28/29 hastada (%86,4), ve sadece heater probe tedavisinde 19/20 hastada (%95) gerçekleşti.Tedavi sonucu olarak, hastanede yatılan süre içerisinde tekrar kanama, sadece epinefrinenjeksiyonunda 6 hastada (%15,4), epinefrin ve heater probe kombinasyonunda 2 hastada (%6,1),epinefrin enjeksiyonu ve gold probe kombinasyonunda 3 hastada (%10,7), ve sadece heater probetedavisinde 2 hastada (%10,5) gözlenmiş olup; dört grubun arasında istatistiksel olarak anlamlı birfarklılık yoktu. 6 hastada kanama durdurulamadı ve cerrahi operasyona verildi. Hastalarınortalama yatış süreleri 5,18±2,88 gün ve ortalama transfüzyon sayıları 3,2±2,88 ünite olarakbulundu. Sonuç. Yüksek riskli veya kanamakta olan ülserlerde, endoskopik adrenalinenjeksiyonunu takiben heater veya gold probe tedavisinin eklenmesinin yalnızca epinefrinenjeksiyon tedavisine göre daha avantajlı olabileceği gözlemlendi. Çalışmadaki hasta sayısınındüşük olması nedeniyle gruplar arasında istatistiksel olarak anlamlı bir fark saptanamadı.

Yüksek riskli veya kanayan ülserlerde ikili endoskop ik tedaviler ile tekli tedavilerin karşılaştırılması: retrospektif bir çalışma

Aim. Peptic ulcer bleeding is a common medical emergency and a potentially life-threateningevent. Endoscopic treatment reduces the morbidity and mortality associated with peptic ulcerbleeding. The aim of this study is to compare the efficacy of dual endoscopic therapies versusendoscopic monotherapy in reducing rate of recurrent bleeding, need for surgery, and death inpatients with active peptic ulcer bleeding. Method. Data of 125 patients who applied to AkdenizUniversity Hospital with active bleeding, or high-risk ulcers detected by endoscopy wereretrospectively investigated. Epinephrine alone injection was applied to 43 patients andepinephrine plus heater probe treatment were applied to 33 patients. Gold probe and epinephrineinjection combination were applied to 29 patients and only heater probe treatment was applied to20 patients. Results. Initial endoscopic haemostasis was achived in 39/43 patients (81.7%) whoreceived epinephrine injection alone, 33/33 patients (100%) who received additional heater probetreatment, 28/29 patients (86.4%) who received additional gold probe treatment, and 19/20 patients(95%) who received heater probe treatment alone. Treatment outcome was determined in fourtreatment groups by clinical rebleeding ratios during the hospital stay. Clinical rebleeding wasobserved in 6 patients (15.4%) in the epinephrine alone group, in 2 patients (6.1%) in additionalheater probe treatment group, in 3 patients (10.7%) in additional gold probe group, and in 2patients (10.5%) in heater probe treatment alone group. We did not find a significant differencebetween these four groups by means of clinical rebleeding ratios. There was no statisticallysignificant difference in four groups. Requirement for emergent operation was observed in 6patients, and mean blood transfusion was 3.2±2.88 units, and mean hospital stay was 5.18±2.88days. Conclusion. Addition of heater probe and gold probe treatment after endoscopic adrenalineinjection could have an advantage in bleeding and high-risk ulcers. Lack of statistical differencebetween the groups could be due to low number of patients.

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