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• W2078343914 abstract "For severe non-variceal UGI hemorrhage (NV-UGIH), no previous reports have prospectively compared hemostasis with larger, stronger hemoclipping (CLIP) to thermal coagulation nor outcomes for very high-risk patients (pts) with severe co-morbidities. Purposes: In a prospective study of very high risk pts with severe NV-UGIH, 1. to compare the efficacy & safety of epinephrine injection plus either multipolar probe (MPEC) or hemoclipping (Boston Scientific Corp., Resolution Clip), and 2. to contrast 30 day outcomes. Methods: Both pts who were randomized and those too sick to be randomized were included in this intention-to-treat analysis of very high-risk pts with co-morbidities and severe NV-UGIH. Moribund pts, malignancies, varices, or angioma syndromes were excluded. Pts with ulcers, Mallory Weiss tears, Dieulafoy's & other lesions were included if they had active bleeding, a non-bleeding visible vessel (NBVV), or adherent clot. Epinephrine (1:20,000) was injected in 1cc aliquots into the base of the lesion in 4 quadrants to slow bleeding. Clots were then removed with cold guillotining. Active bleeding, NBVV, or clot pedicles were then treated with either MPEC or CLIP. All pts received high dose IV PPI & treatment of H.pylori if present. Data were prospectively collected for 30 days and entered onto computer files. SAS was utilized for data management. Results: Background variables, prognosis scores, inpatient vs. outpatient start of bleeding, lesion types, and rates of stigmata were not significantly different for the two treatment groups. All pts had one or more severe co-morbidities. Pts had a mean total of 6.4 ± 0.8 URBC, 2.6 ± 0.8 UFFP, & 1 ± 0.3 platelet packs transfused. See Table for 30 day outcomes (∗p < 0.05). One perforation occurred after Inj-MPEC (3.7%). 2 pts in each group were crossed over to the opposite treatment either because of failure of initial or repeat hemostasis for bleeding (rates 5.4% Inj-CLIP vs. 7.4% Inj-MPEC). Conclusions: For very high risk pts with severe co-morbidities & NV-UGIH: 1. Combination injection-hemoclipping resulted in significantly lower rebleeding & retreatment rates than injection-MPEC. 2. Rates of major complications & crossovers were low & not significantly different. Further improvements in medical & endoscopic treatment of very high-risk patients with NV-UGIH are recommended. Supported in part by BSC, NIH grants (K24-DK002650) & CURE Human Studies Core (P30-DK041301)." @default.
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• W2078343914 date "2008-04-01" @default.
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• W2078343914 title "Hemostasis of Very High Risk Patients with Severe Non-Variceal UGI Hemorrhage Comparing Injection-Hemoclipping with Injection-MPEC" @default.
• W2078343914 doi "https://doi.org/10.1016/j.gie.2008.03.140" @default.
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