Upper GI bleed: adding laser photocoagulation to adrenaline for endoscopic haematostasis for patients with peptic ulcer had no clear benefit.

Clinical bottom line (level 1b-)

  1. Patients with a GI bleed from a peptic ulcer with a visible vessel who had laser photocoagulation and epinephrine injection compared with epinephrine alone, were not clearly less likely to require surgery for rebleeding.
Loizou and Bown: Gut 1991; 32: 1100-1103
Expires January 2003

The study

Unblinded ?concealed randomised trial ?with intention-to-treat
Setting: university hospital, UK

42 patients (aged mean 61, 74% male) haematemesis or melena from endoscopically-proven peptic ulcers with bleeding or non-bleeding visible vessels.
Note:
  • All patients had endoscopy within 18 hours of admission. This was repeated if necessary.
  • Patients were stratified for presence or absence of bleeding from the visible vessel, before randomisation.


Control Group: (n = 21, 21 analysed): epinephrine 1:10 000 injection into ulcer base as close to the vessel as possible
Experimental Group: (n = 21, 21 analysed): epinephrine 1:10 000 injection followed by Nd:YAG laser.
All patients had 300 mg oral ranitidine daily for one week, and blood transfusions as required.
100% followed for ?
Outcome notes:
  • emergency surgery required : from failure to achieve haemostasis: fresh haematemesis, fresh melena with clinical shock or falling Hb despite transfusion, fresh blood in GI tract on repeat endoscopy.

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
emergency surgery required unknown 3
(14.29%)		 0
(0.0%)		 100%
(25% to 100%)		 14.29%
(-0.68% to 29.25%)		 7
(NNT = 3 to infinity;
NNH = 147 to infinity)

Comments

  1. No patient died or suffered bleeding complications in either group.
  2. The study is too small to show any difference between the two treatments.

    Citation

    1. Loizou LA, and Bown SG: Endoscopic treatment for bleeding peptic ulcers: randomised comparison of adrenaline injection and adrenaline injection + Nd:YAG laser photocoagulation. Gut 1991; 32: 1100-1103
    Contributor: Chris Ball and Musab Hayatli, Unknown Month 1999
    Reviewer:

    Clinical Question.
    Patient upper GI bleed, peptic ulcer
    Intervention or Exposure epinephrine alone
    Comparison laser photocoagulation and epinephrine
    Outcome death, rebleed