https://www.gastrojournal.org/article/0016-5085(92)91793-4/pdf

Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis.

Stigmata of hemorrhage in bleeding peptic ulcers: an interobserver agreement study among international experts

https://www.giejournal.org/article/S0016-5107(95)70191-5/pdf

Prospective validation of the Baylor bleeding score for predicting the likelihood of rebleeding after endoscopic hemostasis of peptic ulcers

STUDY OBJECTIVE To assess the efficacy and safety of treatment with endoscopic multipolar electrocoagulation in patients who have ulcers with nonbleeding visible vessels. DESIGN Prospective, randomized, sham-controlled trial; patients were followed until their discharge from the hospital. SETTING Urban, nonreferral county hospital. PATIENTS Consecutive sample of 75 patients who had a bloody nasogastric aspirate sample, melena, or hematochezia; unstable vital signs, a transfusion of at least two units of blood in 12 hours, or a drop in the hematocrit of at least 0.06 in 12 hours; and endoscopic evidence of an ulcer with a nonbleeding visible vessel. INTERVENTION Sham or real multipolar electrocoagulation at the time of diagnostic endoscopy. MEASUREMENTS AND MAIN RESULTS Compared with the control group, the group receiving multipolar electrocoagulation showed marked improvement in the following variables; rebleeding (18% compared with 41%, P less than 0.05; difference, 23%; 95% CI, 3% to 43%); need for emergency surgery (8% compared with 30%, P less than 0.05; difference, 22%; CI, 5% to 39%); mean number of hospital days (4.3 +/- 0.4 compared with 6.2 +/- 0.7, P less than 0.05; difference, 1.9; CI, 0.4 to 3.4); and cost of hospitalization ($3790 +/- $410 compared with $5730 +/- $650, P less than 0.05; difference, $1940; CI, $400 to $3480). The mean transfusion requirement in the treatment group was 1.6 +/- 0.3 as compared with 3.0 +/- 0.6 units in the control group (P = 0.13; difference, 1.4; CI, 0 to 2.8). The overall mortality was extremely low: Only 1 (1%) of 75 patients died. Bleeding was induced in 7 (18%) of the 38 patients treated with electrocoagulation, and 1 patient required urgent surgery. CONCLUSIONS Endoscopic treatment with multipolar electrocoagulation is beneficial in patients who present with major upper gastrointestinal hemorrhage and are found to have an ulcer with a nonbleeding visible vessel.

Multipolar Electrocoagulation in the Treatment of Peptic Ulcers with Nonbleeding Visible Vessels: A Prospective, Controlled Trial

Study Objective:To assess the efficacy and safety of treatment with endoscopic multipolar electrocoagulation in patients who have ulcers with nonbleeding visible vessels. Design:Prospectiv...

Multipolar Electrocoagulation in the Treatment of Peptic Ulcers with Nonbleeding Visible Vessels

With the aim of evaluating, in a controlled prospective fashion, the efficacy of monopolar electrocoagulation in the emergency treatment of bleeding gastric and stomal ulcers, 37 patients were studied: 16 were electrocoagulated (EC group) while the remaining 21 were treated by conventional methods (control group). The hemorrhage recurred in only one of the 16 patients belonging to the EC group, but in 11 of the 21 control patients (p less than 0.0005). Transfusion requirements were also reduced in the EC group (p less than 0.05), with no significant difference in relation to mortality. Stratifying the results according to hemorrhagic activity, electrocoagulation should be clearly effective in those patients with spurting hemorrhage, taking into account several limitations: deep ulcers bearing gross vessels, and lack of cooperation by the patient. Prophylactic treatment of the bleeding ulcer with a visible non-spurting vessel may be indicated whenever we make a proper selection of the patients with a greater possibility of hemorrhagic recurrence.

Efficacy of monopolar electrocoagulation in the treatment of bleeding gastric ulcer: a controlled trial.

To investigate the significance of gastric xanthelasma, a retrospective review of 109 cases with an endoscopic diagnosis of this lesion was undertaken. A predominance in older patients was noted, with a similar distribution in antrum and fornix. In 15 cases (16.6%) they were multiple. They were occasionally associated with gastric erosions. In particular they were associated with chronic gastritis and intestinal metaplasia (48.9%). It is therefore concluded that gastric xanthelasma is not a rare lesion and that it is frequently associated with senile degenerative changes in the gastric mucosa.

Retrospective endoscopic analysis of gastric xanthelasma in the non-operated stomach.

Short term sclerotherapy (by injection(s) around the bleeding point) is used for immediate control of massive haemorrhage from oesophagogastric varices. The usefulness of longterm sclerotherapy once short term sclerotherapy has been successfully carried out was assessed. Two treatment groups were studied: 50 patients were treated by 'combined' (short term followed by longterm) sclerotherapy; 56 patients were treated by short term sclerotherapy only. Patients included in the second group were treated by short term sclerotherapy only if a variceal rebleeding was present. The overall cumulative proportion of patients rebleeding was not significantly different in either group. Combined sclerotherapy patients, however, experienced less episodes of variceal haemorrhage and the source of haemorrhage was different (p < 0.002). Combined sclerotherapy was more efficient in preventing bleeding from oesophageal bleeding points but not those arising from a junctional source (p < 0.05). A greater incidence of oesophageal rebleeding was found in those patients whose first source of bleeding was oesophageal (p < 0.05). No significant difference was detected in survival expectancy between either group. In conclusion, after short term sclerotherapy is carried out successfully, those patients with bleeding from variceal bleeding points located on oesophageal mucosa should benefit most from a longterm sclerotherapy programme.

https://gut.bmj.com/content/gutjnl/35/5/687.full.pdf

Combined (short-term plus longterm) sclerotherapy v short-term only sclerotherapy: a randomised prospective trial.

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Papers

Efficacy of monopolar electrocoagulation in the treatment of bleeding gastric ulcer: a controlled trial.

Retrospective endoscopic analysis of gastric xanthelasma in the non-operated stomach.

Combined (short-term plus longterm) sclerotherapy v short-term only sclerotherapy: a randomised prospective trial.