Endoscopic treatment for bleeding peptic ulcers: randomised comparison of adrenaline injection and adrenaline injection + Nd:YAG laser photocoagulation

Peptic ulcer is a condition in which the destructive effects of the highly acidic secretions of the stomach overcome the protective effects of the mucosa (lining) of the stomach and intestines, resulting in the formation of lesions that can cause serious bleeding if blood vessels are injured by the ulcerative process. Mortality resulting from peptic ulcer bleeding occurs almost exclusively among patients over the age of 60 who suffer complications of surgery for recurrent or continued gastrointestinal bleeding. Several endoscopic methods, or nonsurgical procedures in which flexible mechanical devices are introduced through the esophagus to the stomach, have been developed to reduce the necessity for high-risk emergency surgery and consequent risk of mortality. To evaluate the comparative efficacy of gastric adrenaline injections (which cause constriction of the affected blood vessels, reducing bleeding) and adrenaline injections plus photocoagulation by laser beam (stanching the ulcer-induced hemorrhage by exposing the affected blood vessels to laser light), a study was carried out involving 42 patients suffering from peptic ulcer-induced bleeding. Patients were divided into two groups, well matched on variables relevant to ulcer severity. One group received endoscopically administered injections of adrenaline; the other group received identical injections of adrenaline in addition to photocoagulation therapy with Nd:YAG laser light. Because previous studies had shown that Nd:YAG laser treatment alone has a beneficial effect, it was not considered to be ethically justifiable to include an untreated control group. Control of bleeding was achieved to a similar extent in both groups; 76 percent of patients receiving adrenaline injections showed cessation of bleeding, whereas 86 percent of the patients receiving combined therapy showed successfully controlled bleeding. There were no deaths or serious complications in either group. Hence the simpler, less expensive treatment (adrenaline injection) appears to be as effective as Nd:YAG laser treatment in the control of peptic ulcer-related hemorrhage. (Consumer Summary produced by Reliance Medical Information, Inc.)