Treating recurrent bleeding from peptic ulcer associated with adherent clot

Endoscopic therapy is superior to medical treatment alone in reducing the rate of recurrent bleeding from peptic ulcer associated with adherent clot, according to research published in the July issue of Gastrointestinal Endoscopy.

Researchers from the USA determined whether removal of clot from an ulcer and endoscopic therapy reduces the frequency of recurrent bleeding.

A total of 56 patients with acute upper GI bleeding from peptic ulcers with adherent clots, and no active bleeding, were enrolled in the multicenter study.

At each center, patients were stratified for age, use of nonsteroidal anti-inflammatory drugs, and ulcer location.

They were then randomized to endoscopic (n = 21) or medical management (n = 35).

Endoscopic therapy consisted of injection of the base of the adherent clot with a solution of epinephrine and mechanical removal of the clot.

Rate of recurrent bleedng: Medical therapy: 34% Endoscopic therapy: 5%

Gastrointestinal Endoscopy

The base of the ulcer and any stigmata of bleeding were then coagulated, until cavitation and adequate coagulation were obtained.

Individuals in both groups received standard medical therapy for peptic ulcer.

Patients were evaluated for recurrence of bleeding for 1 month.

The team found that rates of recurrent bleeding were 34% in the medical treatment arm versus 5% in the endoscopic treatment arm.

Dr Brian L. Bleau, of the Tacoma Digestive Diseases, Tacoma, Washington, concluded on behalf of his colleagues, "We studied patients with GI bleeding caused by gastric or duodenal ulcers, with an adherent clot found on endoscopy.

"In these patients, endoscopic therapy with injection of the base of the clot, clot removal, and heat probe coagulation significantly reduces the rate of recurrent bleeding compared with medical therapy alone."