The benefit of nonsurgical therapy in the treatment of active nonvariceal upper gastrointestinal tract hemorrhage is uncertain. I performed a prospective controlled trial of endoscopic multipolar electrocoagulation for active upper gastrointestinal hemorrhage. Patients were considered for entry if they had a bloody nasogastric aspirate, melena, or hematochezia, and any of the following: unstable vital signs, a requirement of greater than or equal to 2 units of blood per 12 hours, or a drop in hematocrit of greater than or equal to 6 percent in 12 hours. Forty-four patients were randomly assigned to receive multipolar electrocoagulation or sham multipolar electrocoagulation if endoscopy revealed active bleeding from an ulcer (24 patients), a Mallory-Weiss tear (17), or a vascular malformation (3). The group receiving multipolar electrocoagulation did significantly better in terms of hemostasis (90 percent vs. 13 percent, P less than 0.0001), mean (+/- SE) transfusion requirements (2.4 +/- 0.9 vs. 5.4 +/- 0.9 U; P = 0.002), mean number of hospital days (4.4 +/- 0.8 vs. 7.2 +/- 1.1, P = 0.02), and percentage needing emergency surgery or another intervention (14 vs. 57 percent, P = 0.01). Although mortality was lower in the group receiving multipolar electrocoagulation (0 vs. 13 percent), this difference was not statistically significant. The mean cost of hospitalization for treated patients was less than half that for the controls ($ 3,420 +/- 750 vs. $ 7,550 +/- 1,480, P = 0.001). I conclude that multipolar electrocoagulation markedly improves the hospital course in patients with major, nonvariceal upper gastrointestinal hemorrhage.
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Wilcox, C., Lopes, T. L
(2009). A randomized trial comparing endoscopic stenting to a sham procedure for chronic pancreatitis. Clin Trials
6: 455-463
[Abstract]
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(2004). Management of haematemesis and melaena. Postgrad. Med. J.
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Palmer, K R
(2002). Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut
51: iv1-6
[Full Text]
Ghosh, S, Watts, D, Kinnear, M
(2002). Management of gastrointestinal haemorrhage. Postgrad. Med. J.
78: 4-14
[Abstract][Full Text]
Hepworth, C C, Kadirkamanathan, S S, Gong, F, Swain, C P
(1998). A randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels. Gut
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[Abstract][Full Text]
Hay, J. A., Maldonado, L., Weingarten, S. R., Ellrodt, A. G.
(1997). Prospective Evaluation of a Clinical Guideline Recommending Hospital Length of Stay in Upper Gastrointestinal Tract Hemorrhage. JAMA
278: 2151-2156
[Abstract]
Chung, S. S C, Lau, J. Y W, Sung, J. J Y, Chan, A. C W, Lai, C W, Ng, E. K W, Chan, F. K L, Yung, M Y, Li, A. K C
(1997). Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. BMJ
314: 1307-1307
[Abstract][Full Text]
Saltzman, J. R., Zawacki, J. K.
(1997). Therapy for Bleeding Peptic Ulcers. NEJM
336: 1091-1093
[Full Text]
Laine, L., Peterson, W. L.
(1994). Bleeding Peptic Ulcer. NEJM
331: 717-727
[Full Text]
Sacks, H. S., Chalmers, T. C., Blum, A. L., Berrier, J., Pagano, D.
(1990). Endoscopic Hemostasis: An Effective Therapy for Bleeding Peptic Ulcers. JAMA
264: 494-499
[Abstract]
Laine, L.
(1989). Multipolar Electrocoagulation in the Treatment of Peptic Ulcers with Nonbleeding Visible Vessels: A Prospective, Controlled Trial. ANN INTERN MED
110: 510-514
[Abstract]
(1987). NEW ENDOSCOPIC TECHNIQUE FOR TREATING UPPER GI BLEEDING. JWatch General
1987: 37-37
[Full Text]
