Author/Editor		Skok, Pavel; Skok, Marija
Title		Peptic ulcer hemorrhage: comparison of efficacy of two methods of endoscopic hemostasis - a prospective study
Translated title		Krvaveča peptična razjeda: primerjava učinkovitosti dveh metod endoskopske hemostaze - prospektivna raziskava
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. 4
Publication year		2004
Volume		str. 181-6
Language		eng
Abstract		Background. Interventional endoscopy has largely reduced mortality in patients with peptic ulcer hemorrhage. Study aims. To evaluate the efficacy and safety of endoscopic hemostasis with argon plasma coagulation and injection sclerotherapy in bleeding peptic ulcer and determine the mortality of patients in a prospective, controlled study. Patients and methods. The study includes 100 patients with peptic ulcer hemorrhage (male 63, female 37, av. age 57.1 years, SD +/- 16, span 26-80; gastric ulcer 50 patients, duodenal ulcer 50 patients) in the period between 1 Jan. 1999 and 15 May 2000 treated in our institution. The bleeding activity was determined according to Forrest classification. Fifty patients were randomized to receive argon plasma coagulation (ARCO 2000 Electro Surgery unit, group A) and in fifty patients injection sclerotherapy (sclerosing with diluted adrenalin 1:10,000 plus polidocanol 1%, group B) was performed. The groups did not differ with respect to age, sex, site, severity of bleeding, use of NSAID and additional diseases. Results. Clinically and endoscopically diagnosed reebleding occured in 7/50 patients (14%) in group A and in 9/50 patients (18%) in group B; p = 0.78. The majority of reebleding occured within 48 hours after endoscopic hemostasis, group A 4/7 (57.1%), group B 7/9 (77.7%), p = 0.74. Repeated endoscopic hemostasis did not prove successful in 8 patients (group A 3/50, 6%, group B 5/50, 10%), p = 0.71. Seven patients were treated operatively. The total mortality rate was 9% (9/100 patients, group A 4/50, 8%, group B 5/50, 10%), p > 0.05. Only one patient died due to peptic ulcer hemorrhage, other 8 patients died due to concomitant diseases. Conclusions. Argon plasma coagulation seems to be an effective and safe alternative to injection sclerotherapy and other hemostatic modalities in peptic ulcer hemorrhage.
Summary		Izhodišča. Akutne krvavitve iz zgornje prebavne cevi sodijo med pogosta nujna stanja, s katerimi se srečujemo v urgentni medicini in gastroenterologiji. Peptična razjeda je najpomembnejši vir krvavitev. V Sloveniji je letna incidenca krvaveče peptične razjede 118 bolnikov/100.000 prebivalcev. Bolezen je povezana s pomembno umrljivostjo, še zlasti pri starejših bolnikih s pridruženimi obolenji. Po podatkih iz literature so endoskopske hemostatske metode in zdravljenje v usmerjenih intenzivnih enotah vplivale na zmanjšanje umrljivosti pri teh bolnikih v zadnjem obdobju. Namen raziskave. Namen raziskave je bil ovrednotiti učinkovitost in varnost argonske plazemske koagulacije v primerjavi z injekcijskim sklerozacijskim zdravljenjem pri krvaveči peptični razjedi in ugotoviti umrljivost teh bolnikov v prospektivni, kontrolirani raziskavi. Bolniki in metode. Raziskava vključuje 100 bolnikov s krvavečo peptično razjedo, 63 moških in 37 žensk, povprečne starosti 57,1 leta, SD +/- 16 let, v razponu od 26-80 let. Med njimi je bilo 50 bolnikov z želodčno razjedo in 50 bolnikov z razjedo dvanajstnika, zdravljenih zaradi krvavitve v naši ustanovi v obdobju od 1. januarja 1999 do 15. maja 2000. Vsi bolniki so prvič zakrvaveli zaradi razjede. Ob nujni endoskopski preiskavi je bila aktivnost krvaveče razjede ocenjena v skladu z Forrestovo klasifikacijo. Po randomizaciji smo pri 50 bolnikih opravili endoskopsko hemostazo z argonsko plazemsko koagulacijo (instrument ARCO 2000, skupina A), pri 50 bolnikih pa injekcijsko sklerozacijsko zdravljenje (z razredčenim adrenalinom v razmerju 1:10.000 in 1% polidokanolom, skupina B). Bolnike smo zdravili v enoti internistične intenzivne medicine, kjer so bili hemodinamsko nadzorovani. Prejemali so simptomatsko zdravljenje, vključno s transfuzijami. (Izvleček prekinjen pri 2000 znakih).
Descriptors		PEPTIC ULCER HEMORRHAGE HEMOSTASIS, ENDOSCOPIC ELECTROCOAGULATION SCLEROTHERAPY STOMACH ULCER DUODENAL ULCER INTENSIVE CARE UNITS TREATMENT OUTCOME PROSPECTIVE STUDIES