A randomized trial of monopolar soft-mode coagulation versus heater probe thermocoagulation for peptic ulcer bleeding

Tomokazu Nunoue, Ryuta Takenaka, Keisuke Hori, Noriko Okazaki, Kenta Hamada, Yuki Baba, Yasushi Yamasaki, Yoshiyasu Kono, Hiroyuki Seki, Toshihiro Inokuchi, Koji Takemoto, Akihiko Taira, Hirofumi Tsugeno, Shigeatsu Fujiki, Yoshiro Kawahara, Hiroyuki Okada

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background and Aim: Endoscopic therapy has been demonstrated to be effective in achieving hemostasis for bleeding peptic ulcers. Thermal coagulation is one of the most commonly used methods, with a high success rate. Recently, endoscopic submucosal dissection for early gastric carcinoma was developed and hemostasis with soft coagulation using hemostatic forceps was introduced. The aim of this study was to compare the hemostatic efficacy of soft coagulation with heater probe thermocoagulation for peptic ulcer bleeding. Methods: Patients who visited our hospital with hematemesis or melena underwent emergency endoscopy. Inclusion criteria were presentation with an actively bleeding ulcer, a nonbleeding visible vessel, or an adherent clot. Patients were excluded if they were unwilling to give written informed consent or had a bleeding gastric malignancy. Patients were randomized to receive endoscopic hemostasis with soft coagulation (Group S) or heater probe thermocoagulation (Group H). The primary endpoint was the primary hemostasis rate and secondary endpoints were rebleeding rate, complications, and the procedure time. Results: Between May 2010 and February 2012, a total of 111 patients (89 gastric ulcers and 22 duodenal ulcers) were enrolled. Primary hemostasis was achieved in 54 patients (96%) in Group S and 37 (67%) in Group H (P<0.0001). Rebleeding occurred in 7 patients in Group H and none in Group S. Of these 7 patients, urgent surgery was performed in 1. Perforation occurred in 2 patients in Group H, which was managed conservatively. Conclusions: For patients with gastroduodenal ulcer bleeding, soft coagulation using monopolar hemostatic forceps is more effective than heater probe thermocoagulation for achieving hemostasis.

Original languageEnglish
Pages (from-to)472-476
Number of pages5
JournalJournal of Clinical Gastroenterology
Volume49
Issue number6
DOIs
Publication statusPublished - Jun 24 2015

Keywords

  • duodenal ulcer bleeding
  • gastric ulcer bleeding
  • heater probe thermocoagulation
  • peptic ulcer bleeding
  • soft coagulation

ASJC Scopus subject areas

  • Gastroenterology

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  • Cite this

    Nunoue, T., Takenaka, R., Hori, K., Okazaki, N., Hamada, K., Baba, Y., Yamasaki, Y., Kono, Y., Seki, H., Inokuchi, T., Takemoto, K., Taira, A., Tsugeno, H., Fujiki, S., Kawahara, Y., & Okada, H. (2015). A randomized trial of monopolar soft-mode coagulation versus heater probe thermocoagulation for peptic ulcer bleeding. Journal of Clinical Gastroenterology, 49(6), 472-476. https://doi.org/10.1097/MCG.0000000000000190