Gastroenterology
Volume 123, Issue 2 , Pages 407-413 , August 2002

Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots

  • Dennis M. Jensen

      Affiliations

    • CURE Digestive Disease Research Center, UCLA School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
    • ,
  • Thomas O.G. Kovacs

      Affiliations

    • CURE Digestive Disease Research Center, UCLA School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
    • ,
  • Rome Jutabha

      Affiliations

    • CURE Digestive Disease Research Center, UCLA School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
    • ,
  • Gustavo A. Machicado

      Affiliations

    • CURE Digestive Disease Research Center, UCLA School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
    • Northridge Hospital Medical Center, Van Nuys, California
    • ,
  • Ian M. Gralnek

      Affiliations

    • CURE Digestive Disease Research Center, UCLA School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
    • ,
  • Thomas J. Savides

      Affiliations

    • UCSD School of Medicine, San Diego, California
    • ,
  • James Smith

      Affiliations

    • Oschner Foundation Clinic, New Orleans, Louisiana
    • ,
  • Mary Ellen Jensen

      Affiliations

    • CURE Digestive Disease Research Center, UCLA School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
    • ,
  • Gwen Alofaituli

      Affiliations

    • CURE Digestive Disease Research Center, UCLA School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
    • ,
  • Jeff Gornbein

      Affiliations

    • CURE Digestive Disease Research Center, UCLA School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California

Received 18 February 2002 ,Accepted 28 February 2002.

References 

  1. Jensen DM. Endoscopic control of non-variceal upper gastrointestinal hemorrhage. In: 3rd ed.  Yamada T,  Alpers D,  Laine L,  Owyang C,  Powell D editor. Textbook of gastroenterology. Philadelphia: Lippincott; 1999;p. 2857–2879
  2. Swain CP, Storey DW, Bown SG, Heath J, Mills TN, Salmon PR, et al. Nature of the bleeding vessel in recurrently bleeding gastric ulcers. Gastroenterology. 1986;90:595–608
  3. Swain CP, Salmon PR, Kirkham JS, Bown SG, Northfield TC. Controlled trial of Nd: YAG laser photocoagulation in bleeding peptic ulcer. Lancet. 1986;1:1113–1116
  4. National Institutes of Health Consensus Development Conference . Therapeutic endoscopy and bleeding ulcers. JAMA. 1989;262:1369–1372
  5. Laine L, Stein C, Sharma V. A prospective outcome study of patients with clot in an ulcer and the effect of irrigation. Gastrointest Endosc. 1996;43:107–110
  6. Freeman ML. The current endoscopic diagnosis and intensive care unit management of severe ulcer and other nonvariceal upper gastrointestinal hemorrhage. Gastrointest Endosc Clin N Am. 1991;1:209–239
  7. Jensen DM. Current diagnosis and treatment of severe ulcer hemorrhage. Clinical update. In:  Lieberman D editors. ASGE. 6:1999;p. 1–4
  8. Lau JY, Chung SC, Leung JW, Lo KK, Yung MY, Li AK. The evolution of hemorrhage in bleeding peptic ulcers: a sequential endoscopic study. Endoscopy. 1998;30:513–518
  9. Matthewson K, Swain CP, Bland M, Kirkham JS, Bown SG, Northfield TC. Randomized comparison of Nd:YAG laser, heater probe, and no endoscopic therapy for bleeding peptic ulcers. Gastroenterology. 1990;98:1239–1244
  10. Jensen DM, Kovacs TOG, Jutabha R, Randall GM, Cheng S, Jensen ME, et al. Final results and cost assessment of endoscopic vs. medical therapies for prevention of recurrent ulcer hemorrhage from adherent clots in a randomized controlled trial. Gastrointest Endosc. 1995;41:279; (abstr)
  11. Bleau BF, Gostout CJ, Shaw MJ, Keate RF, Harford WV, Bracy W, et al. Final results: rebleeding from peptic ulcers associated with adherent clots: a prospective randomized controlled study comparing endoscopic with medical therapy. Gastrointest Endosc. 1997;45:AB87; (abstr)
  12. Jensen DM, Kovacs TOG, Jutabha R, Machicado GA, Savides T, Smith J. A safe and effective technique for endoscopic removal of adherent clots from GI lesions: cold guillotining after epinephrine injection. Gastrointest Endosc. 1996;43:A25; (abstr)
  13. Jensen DM. Thermal probe or combination therapy for non-variceal UGI hemorrhage. Tech Gastrointest Endosc. 1999;1:107–114
  14. Johnston JH, Jensen DM, Auth D. Experimental comparison of endoscopic Yttrium-aluminum-garnet laser, electrosurgery, and heater probe for canine gut artery coagulation: the importance of vessel compression and avoidance of tissue erosion. Gastroenterology. 1987;92:1101–1108
  15. Jensen DM, Kovacs TOG, Jutabha R, Machicado GA, Gralnek IM, Savides JT, et al. Randomized controlled trial of medical therapy compared to endoscopic therapy for prevention of recurrent ulcer hemorrhage in patients with non-bleeding adherent clots. Gastrointest Endosc. 2000;51:AB131; (abstr)
  16. Fleming TR, Harrington DP, O'Brien PC. Designs of group sequential tests. Control Clin Trials. 1984;5:348–361
  17. Bailar JC, Mosteller F. Medical uses of statistics. In: 2nd ed. Waltham, MA: N Engl J Med Books; 1992;p. 183–184
  18. Jensen DM, Smith J, Savides TJ, Kovacs TOG, Jutabha R, Gralnek IM, et al. Randomized controlled study of combination epinephrine injection and Gold probe compared to Gold probe alone for hemostasis of actively bleeding peptic ulcers. Gastrointest Endosc. 2000;51:AB201; (abstr)
  19. Jensen DM, Kovacs TOG, Jutabha R, Gralnek IM, Machicado GA, Savides TJ, et al. Randomized prospective study of bipolar coagulation alone compared to combination epinephrine injection and bipolar coagulation for prevention of rebleeding from ulcers with non-bleeding visible vessels. Gastrointest Endosc. 2000;51:AB201; (abstr)
  20. Jensen DM, Machicado GA. Colonoscopy for diagnosis and treatment of severe lower gastrointestinal bleeding: routine outcomes and cost analysis. Gastrointest Endosc Clin N Am. 1997;7:477–498
  21. Jensen DM, Machicado GA, Jutabha R, Kovacs TOG. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342:78–82

☆ Address requests for reprints to: Dennis M. Jensen, M.D., CURE Digestive Disease Research Center, Building 115, Room 318, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, California 90073. e-mail: djensen@mednet.ucla.edu; fax: (310) 794-2908.

☆☆ Supported in part by NIH RO1 DK 33273, NIH 1K24DK 02650, and NIH DK 41301 (CURE Human Studies CORE), by Microvasive-Boston Scientific Corporation, and by a Veterans Administration HSR & D Career Development Award (to I.M.G.).

PII: S0016-5085(02)00118-X

doi: 10.1053/gast.2002.34782

Gastroenterology
Volume 123, Issue 2 , Pages 407-413 , August 2002

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