Su1925 Characteristics of Gastric Polyps in African Americans and Hispanics

Abstract

[Introduction] Endoscopic therapy has been demonstrated to be effective in achieving hemostasis for bleeding peptic ulcers. Thermal coagulation is one of the most commonly used methods with a high success rate. Recently, endoscopic submucosal dissection for early gastric carcinoma was developed and hemostasis with soft coagulation using hemostatic forceps was introduced. We applied endoscopic hemostasis with soft coagulation to gastroduodenal ulcer bleeding and reported that initial and final hemostatic rates were 95% and 100%, respectively. The aim of this study was to compare the hemostatic effects of soft coagulation with those of heater probe thermocoagulation for peptic ulcer bleeding. [Methods] Patients who visited our hospital with hematemesis or melena and required life-saving endoscopic treatment were recruited. Inclusion criteria in this study were that they presented with an actively bleeding ulcer, a nonbleeding visible vessel, or an adherent clot. Patients were excluded if they were unwilling to give written informed consent or had bleeding gastric malignancy. Patients were randomized to receive endoscopic hemostasis with soft coagulation (Group S) or heater probe thermocoagulation (Group H). In Group S, endoscopic hemostasis with soft coagulation was performed using a monopolar hemostatic forceps (FD410LR, Olympus) and an electrosurgical unit (ICC-200, ERBE) at 70W. In Group H, a heater probe unit (HPU-20, Olympus) was used and pulses of 20 to 30 J were given. When the allocated treatment failed to achieve hemostasis, the other method was applied. If hemostasis was not obtained using thesemethods, intervention radiology or surgical treatment was applied. Initial hemostasis was declared when hemostasis was obtained by the single allocated method and second-look endoscopy revealed no bleeding from ulcers. The primary endpoint was the initial hemostasis rate and secondary endpoints were the rebleeding rate, complications and the procedure time. [Results] Between May 2010 and February 2012, a total of 111 patients (89 gastric ulcers and 22 duodenal ulcers) were enrolled. There were no significant differences in the background characteristics between Groups S and H. Initial hemostasis was achieved in 54 patients (96%) in Group S and 37 patients (67%) in Group H (p , 0.0001). Rebleeding occurred in 4 patients in Group H and none in Group S. Of these patients, urgent surgery was performed in one patient. Perforation occurred in two patients in Group H, which were managed conservatively. The duration of endoscopic therapy was shorter in Group S than in Group H, although not significantly (P = 0.10). [Conclusions] For patients with gastroduodenal ulcer bleeding, soft coagulation using a monopolar hemostatic forceps provides an advantage in achieving hemostasis compared with heater probe thermocoagulation.