Epinephrine injection plus hemoclip placement provide better outcomes as compared to epinephrine injection alone in patients with high-risk bleeding gastric ulcer

Introduction: The frequency of gastric ulcer bleeding and the related morbidity and mortality have shown a stable figure for many years despite the use of various methods of endoscopic hemostasis. In high-risk bleeding ulcers local epinephrine injection and/or hemoclip placement to the exposed vessel are established methods for control bleeding and for prevent rebleeding. The aim of the present retrospective study is to compare the efficacy of epinephrine injection (Epi) alone and epinephrine injection +hemoclip placement (Epi+H) in the treatment of high-risk bleeding gastric ulcers. Patients and methods: During a three years period (2004 January-2006 December) 78 patients (mean age: 62ys, 66% male) with high-risk bleeding gastric ulcer were treated endoscopically with local Epi alone (n=62) and with Epi+H (n=16). The Forrest-class distribution (Forrest I/a: 20%, I/b: 23%, I/c: 3%, II/a: 54%), the frequency of comorbidity (89%) and the use of NSAIDs or anticoagulant (80%) did not differed significantly between the treatment groups. Outcome measures as mortality, rebleeding rates, and the need for surgery were compared between the two groups. Results: Mortality rates were higher in patients treated by Epi (19%) as compared to the Epi+H group (6.3%), OR=1.2 95%CI (0.9–1.4), p=0.28. The rate of rebleeding was 28% in the Epi group and 19% in the Epi+H group[p=0.74, OR=1.0 (0.8–1.3)]. Surgery was needed in 35% of pts in the Epi group as compared to 12.5% in the Epi+H group [p=0.12, OR=1.2 (1.0–1.5)]. By multivariate analysis only rebleeding proved to be a significant predictor of mortality [p=0.001, OR=5.4 (2.1–8.7). Conclusion: Although the differences in outcome measures were not statistically significant, the present results supports that the Epi+H may provide favorable outcomes of patients with high-risk bleeding gastric ulcers.