The effect of endoscopic hemostasis with alcohol on the mortality rate of nonvariceal upper gastrointestinal hemorrhage. A randomized prospective study.

One hundred and forty-five patients with nonvariceal upper GI hemorrhage, active or with stigmata (Forrest I and II) were divided into two groups according to the day of the week on which emergency endoscopy was performed: group A (78 patients) in which conventional treatment was applied (blood transfusions, antacids, cimetidine, pirenzepine), and group B (65 patients) in which endoscopic hemostasis with absolute alcohol (Asaki's method) was performed. The two groups were comparable as regards age, sex distribution and type of hemorrhage (after Forrest). Emergency surgery was performed in both groups if the bleeding did not stop or if it recurred. Twenty patients (11 in group A and 9 in group B) were operated on some time after the bleeding episode (5-18 days) to prevent new episodes. Absolute alcohol injection achieved hemostasis in all the cases of active hemorrhage (Forrest I) and prevented recurrence in 24 out of 25 cases with a clot or visible vessels (Forrest II), so that emergency surgery was not necessary in any of the patients of group B. Mortality rate was significantly lower in group B than in group A (10 deaths in group A, 2 in group B, p less than 0.05) being explained mainly by the reduced post-operative mortality (18% in group B), due to the small number of the operated patients (28 in groups A, 10 in B; p less than 0.02), especially of those operated on as an emergency (one in the endoscopic hemostasis group as compared with 17 in the conventional treatment group; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

RCT Entities:   Population Interventions Outcomes