■ Pharmacological Therapy of Bleeding Ulcers
Hemostasis cannot be achieved with medical therapy alone. PPI ►
are used, but their benefit is still unproved. If H. pylori is de- ►
tected, eradication therapy should be performed. This can expe- ►
dite healing and lower the risk of recurrence. NSAIDs should be ► discontinued.
■ Endoscopic Techniques
The treatment of choice is endoscopic hemostasis (injection therapy, hemoclips, thermal methods).
■ Injection Therapy
- Therapy of choice
- Safe, economical, can be used to treat rebleeding after prior hemostasis with polidocanol
- Very effective, especially after initial use of epinephrine
- Problem: enlarges tissue lesion, should not be used to treat rebleeding
- Agent of second choice
- Two components (fibrin and thrombin) form a fibrin clot when mixed together. They are mixed at the time of injection.
- Excellent tissue compatibility; very costly, laborious technique
- Very effective for rebleeding
► Physiological saline solution, glucose, ethanol
- Very rarely used today as a solitary treatment
Single-lumen injection needles for epinephrine and polido-canol, double-lumen needles for fibrin glue Epinephrine 1:10000 in physiological saline solution, 1% polidocanol, fibrin glue
Epinephrine (Fig. 4.21)
- Make several injections of 1 mL each around the bleeding ulcer.
- Then inject 1-2 mL into the bleeding site at the ulcer base.
- Inject 1 mL of polidocanol into the bleeding site.
- Caution: Inject no more than 2 mL per ulcer; more could cause a substantial tissue lesion.
- Preflush the needle with physiological saline solution.
- Inject 2 mL of both components into the bleeding site through a double-lumen needle.
- Then flush the needle with physiological saline solution.
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