Evaluation of the Efficacy of Adrenaline Injection Versus Argon Plasma Coagulation Either Alone or Combined in Controlling Acute Bleeding Peptic Ulcer

Amr El Hawary,Emad Moustafa

doi:10.21608/aeji.2018.13309

Abstract

Background and study aim: Evaluating the sequale and outcomes of managing acute bleeding peptic ulcer by using either diluted adrenaline injection or argon plasma coagulation alone versus using both modalities. Materials and Methods: This study was performed over a 1.5-year period from January 2016 to June 2017. Acute bleeding peptic ulcer patients were assigned randomly to either treatment with diluted adrenaline injection (group I), or with an APC application (group II) or treated using both (group III). All groups were compared regarding the rate of initial hemostasis, rate of recurrent bleeding, successful definitive hemostasis, need for emergency surgery and bleeding-related deaths. Results: In total, Session [CurrentTestPartID] patients with acute bleeding peptic ulcer were enrolled randomly in three groups; group I included 20 patients who were treated with endoscopic adrenaline injection, group II included 20 patients and were exposed to Argon plasma coagulation in sessions and group III included 20 patients who were subjected to both modalities. Patients were followed up in ICU and received PPI IV infusion, Endoscopy was performed one week after initial hemostasis, a second look endoscopy was performed in patients who showed recurrent bleeding. Results revealed significant (p<0.05) superior efficacy of both modalities when used together (group III) compared with using either alone as regard inducing initial and permanent hemostasis, controlling rebleeding and minimizing hospital admission days. Conclusion: Using both endoscopic adrenaline injection and argon plasma coagulation as a combined therapy is highly efficacious in managing acute bleeding peptic ulcer than using each alone.

Highlights

Upper gastrointestinal bleeding originates proximal to the ligament of Treitz in the duodenum
The aim of this study is to evaluate the efficacy of endoscopic local adrenaline injection versus argon plasma coagulation in achieving a significant hemostatic effect in bleeding peptic ulcer
Regarding the outcome after endoscopic treatment, Initial hemostasis was achieved in 38 patients (63.3%) of total, patients (50%) of those treated with adrenaline injection, patients (55%) of those treated using argon plasma coagulation and 17 patients

Summary

Introduction

Upper gastrointestinal bleeding originates proximal to the ligament of Treitz in the duodenum. Its main causes are divided into either variceal or non-variceal and there are various sources for non-variceal upper GI bleeding (as severe esophagitis, gastroduodenal erosions, MalloryWeiss tears, and vascular malformations), bleeding peptic ulcer remains the most common cause. Acute bleeding peptic ulcer presented with hematemesis, melena, or both, has significant associated morbidity or mortality [2]. Many scoring systems have been used to stratify risk in upper GI bleeding. The most widely used are the Rockall scores (both pre- and post-endoscopy) and the Glasgow–Blatchford score (GBS)[4], the Rockall scores assess mortality risk, but were never designed directly as decision tools, but that the GBS was designed to predict cases not needing intervention (therapeutic endoscopy or blood transfusion).[5]. Evaluating the sequale and outcomes of managing acute bleeding peptic ulcer by using either diluted adrenaline injection or argon plasma coagulation alone versus using both modalities

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Conclusion