Local Epinephrine Injection Improves the Therapeutic Effect of Nd-YAG Laser Treatment of Arterial Peptic Ulcer Bleeding

Summary

Nd-YAG laser therapy has been shown to be effective in the treatment of gastrointestinal ulcer bleeding. However, a breakdown by bleeding severity shows that its benefit is doubtful in bleeds classified as Forrest la and lla. In a prospective study, we therefore tested a new therapeutic approach combining epinephrine injection into the bleeding site, with subsequent laser coagulation. Thirty-two patients with Forrest la and lla bleeding from gastric or small intestinal ulcers were compared with 51 own historical controls treated by laser coagulation alone. In the combined therapy group, a significantly higher rate of permanent hemostasis was achieved, and mortality and frequency of emergency surgery were significantly reduced. Furthermore bleeding recurred more rarely and only during the later course of the disease. Finally, following epinephrine injection fewer Forrest lla ulcer bleeds were reactivated by laser treatment, and all of these bleeds were stopped by further laser coagulation. Overall, our results demonstrate a clear-cut therapeutic improvement when laser coagulation is preceded by local epinephrine injection.

Key words:

Nd-YAG laser coagulation - Local epinephrine injection - Arterial ulcer bleeding - Therapeutic endoscopy