Skip to main content
SpringerLink
Log in

Endoscopic Injection Therapy of Gastroduodenal Ulcer Hemorrhage: A Randomized Comparison of Fibrin Sealant vs. Polidocanol

  • Conference paper
Endoscopy

Part of the book series: Fibrin Sealing in Surgical and Nonsurgical Fields ((ADMERE,volume 8))

Abstract

In a randomized trial involving 56 patients with acute gastroduodenal ulcer hemorrhage we examined the rebleeding rate after endoscopic local injection of fibrin sealant (group A, n = 30) in comparison to polidocanol (group B, n = 26). Included were ulcers with spurting (Forrest Ia) or oozing bleeding (F lb) or a visible vessel (F IIa). In case of F Ia/Ib the endoscopic therapy in both groups was combined with a preliminary injection of epinephrine (1:104). After endoscopic hemostasis the patients were transferred to the surgical intensive care unit. The patients underwent routine endoscopy 24 h later. If rebleeding signs occurred, emergency endoscopy was performed. In the case of rebleeding or a still visible vessel another injection therapy now with fibrin sealant in both groups was performed. Initial hemostasis was achieved in 100% of cases in group A and in 77% in group B (p ≤ 0.05). Recurrent hemorrhage occurred in 10% in group A and in 38% in group B (p ≤ 0.05). Permanent hemostasis was achieved in 93% in group A and 88% in group B. There were no differences between the two groups in the requirement for emergency surgery or mortality. A tendency toward a lower blood transfusion requirement was observed in group A, but it failed to achieve statistical significance. No complications of injection therapy were noted.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Balanzó J, Sáinz S, Such J, Espinós JC, Guarner C, Cussó X, Mones J, Vilardell F (1988) Endoscopic hemostasis by local injection of epinephrine and polidocanol in bleeding ulcer. A prospective randomized trial. Endoscopy 20: 289–291

    Article  PubMed  Google Scholar 

  2. Berg P, Barina W, Born P, Simon W, Zellmer R, Paul F (1990) Fibrinkleber versus Polidocanol bei der oberen Gastrointestinalblutung. In: Henning H, Soehendra N (eds) Fortschritte der gastroenterologischen Endoskopie. Demeter, Gräfelfing, pp 22–24

    Google Scholar 

  3. Chung SC, Leung FW, Leung JW (1988) Is vasoconstriction the mechanism of hemostasis in bleeding ulcers injected with epinephrine? A study using reflectance spectrophotometry. Gastrointest Endosc 34: 174–175

    Article  Google Scholar 

  4. Cook DJ, Guyatt GH, Salena BJ, Laine LA (1992) Endoscopic therapy for acute nonvariceal gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 102: 139–148

    PubMed  CAS  Google Scholar 

  5. Dennis MB, Peoples J, Hulett R, Auth DC, Proteil RL, Rubin CE, Silverstein FE (1979) Evaluation of electrofulguration in control of bleeding of experimental gastric ulcers. Dig Dis Sci 24: 845–848

    Article  PubMed  CAS  Google Scholar 

  6. Eastwood GL (1992) Endoscopy in gastrointestinal bleeding. Are we beginning to realize the dream? J Clin Gastroenterol 14: 187–191

    Article  PubMed  CAS  Google Scholar 

  7. Eimiller A (1988) Fibrinkleber als Sklerosierungsmittel. In: Manegold BC (ed) Fibrinklebung in der Endoskopie. Springer, Berlin Heidelberg New York, pp 79–84

    Chapter  Google Scholar 

  8. Friedrichs O (1991) Submucöse Fibrinklebung der akuten Ulkusblutung — hat sich das Konzept bewährt? Intensiv Notfallbehandl 16: 163–168

    Google Scholar 

  9. Forrest JA, Finlayson ND, Shearman DJ (1974) Endoscopy in gastrointestinal bleeding. Lancet II: 394–397

    Article  Google Scholar 

  10. Fuchs KH, Wirtz HJ, Schaube H (1992) Endoskopisch-chirurgische Blutstillung im Gastrointestinaltrakt. In: Fuchs KH, Manegold BC (eds) Chirurgische Endoskopie im Abdomen. Blackwell Wissenschaft, Berlin, pp 47–69

    Google Scholar 

  11. Grund KE, Mohl W, Fischer H (1991) Endoskopische Fibrinklebung — Indikation, Ergebnisse und Probleme. Endoskopie Heute 4: 53–54

    Google Scholar 

  12. Johnston JH (1990) Endoscopic risk factors for bleeding peptic ulcer. Gastrointest Endosc 36: S16-S20

    PubMed  CAS  Google Scholar 

  13. Kalabakas A, Swain CP (1992) A comparison of injection and topical application of fibrin tissue glue with injection and thermal methods for the treatment of standard experimental bleeding ulcers. Endoscopy 24: 616–617

    Google Scholar 

  14. Kortan P, Haber G, Marcon N (1986) Endoscopic injection therapy for nonvariceal lesions of the upper gastrointestinal tract. Gastrointest Endosc 32: 145

    Google Scholar 

  15. Laine L (1990) Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers. Gastroenterology 99: 1303–1306

    PubMed  CAS  Google Scholar 

  16. Panés J, Viver J, Forné M, Garcia-Olivares E, Marco C, Garau J (1987) Controlled trial of endoscopic sclerosis in bleeding peptic ulcers. Lancet II: 1292–1294

    Article  Google Scholar 

  17. Prassler R, Barnert J, Richter G, Wienbeck M (1992) Die endoskopische Fibrinklebung bei blutenden Magen- und Duodenalulzera. Intensiv Notfallbehandl 17: 43–47

    Google Scholar 

  18. Randall GM, Jensen DM, Hirabayashi K, Machicado GA (1989) Controlled study of different sclerosing agents for coagulation of canine gut arteries. Gastroenterology 96: 1274–1281

    PubMed  CAS  Google Scholar 

  19. Roggo A, Filippini L (1990) Endoskopische Injektionstherapie bei akuter nichtvariköser oberer Gastrointestinalblutung. Dtsch Med Wochenschr 115: 1227–1231

    Article  PubMed  CAS  Google Scholar 

  20. Rutgeerts P, Gevers AM, Hiele M, Broeckaert L, Coremans G, Janssens J, Vantrappen G (1990) Injection therapy for prevention of rebleeding from peptic ulcers i with protruding vessel: which method is best? Gastroenterology 98: A115

    Google Scholar 

  21. Salm R, Bohle W, Sontheimer J (1991) Peptic ulcer hemorrhage: Local injection of fibrin sealant — experimental and clinical data. Acta Chir Austr 23: 113–116

    Article  Google Scholar 

  22. Siemens F, Paquet KJ, Koussouris P, Mercado MA, Kalk JF (1989) Long-term endoscopic injection sclerotherapy of bleeding esophageal varices. A prospective analysis of results by endoscopy, manometry and 24-h pH-monitoring. Surg Endosc 3: 137–141

    Article  PubMed  CAS  Google Scholar 

  23. Soehendra N, Grimm H, Stenzel M (1985) Injection of nonvariceal bleeding lesions of the upper gastrointestinal tract. Endoscopy 17: 129–132

    Article  PubMed  CAS  Google Scholar 

  24. Strohm WD, Römmele U, Barton E, Paul-Martin C (1994) Injektionstherapie des blutenden Ulcus pepticum mit Fibrin oder Polidocanol. Dtsch Med Wschr 119: 249–256

    Article  PubMed  CAS  Google Scholar 

  25. Villanueva C, Balanzó J, Espinos JC, Fábrega E, Sáinz S, Gonzáles D, Vilardell F (1993) Endoscopic injection therapy of bleeding ulcer: a prospective and randomized comparison of adrenaline alone or with polidocanol. J Clin Gastroenterol 17: 195–200

    Article  PubMed  CAS  Google Scholar 

  26. Wara P (1985) Endoscopic prediction of major rebleeding — a prospective study of stigmata of hemorrhage in bleeding ulcer. Gastroenterology 88: 1209–1214

    PubMed  CAS  Google Scholar 

Download references

Authors
  1. R. Salm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. E. Grund
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Sontheimer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Bustos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Ludwig-Boltzmann-Institut für experimentelle und klinische Traumatologie, Donaueschingenstraße 13, 1200, Wien, Austria

    Günther Schlag

  2. AKH Linz, II. Chirurgie, Krankenhausstraße 9, 4020, Linz, Austria

    Wolfgang Wayand

Rights and permissions

Reprints and permissions

Copyright information

© 1995 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Salm, R., Grund, K.E., Sontheimer, J., Bustos, A., Weber, E. (1995). Endoscopic Injection Therapy of Gastroduodenal Ulcer Hemorrhage: A Randomized Comparison of Fibrin Sealant vs. Polidocanol. In: Schlag, G., Wayand, W. (eds) Endoscopy. Fibrin Sealing in Surgical and Nonsurgical Fields, vol 8. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-79165-9_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-79165-9_2

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-58282-3

  • Online ISBN: 978-3-642-79165-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation