Bleeding ulcer: inject or clip?

The authors retrospectively compared endoscopic injection therapy with endoscopic hemoclipping by examining 113 patients over a 10-yr period between 1985 and 1995 who had gastrointestinal bleeding and who received one or the other procedure. Endoscopic injection using ethanol alone, epinephrine plus ethanol, or aethoxysclelol plus ethanol was performed in 87 cases. Endoscopic hemoclipping was performed in 26 cases from 1993 to 1995. The permanent hemostasis rate of endoscopic injection was 84% and that of endoscopic hemoclipping was 100%. Complications associated with endoscopic injection included enlargement of the ulcer bed, bleeding caused by exposed vessels within the expanded ulcer and one case of perforation. No complications were noted among patients treated with endoscopic hemoclipping.