Which endoscopic therapy modalities are available for treating peptic ulcer disease (PUD)?

Updated: Apr 26, 2021
  • Author: BS Anand, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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Answer

Several modalities of endoscopic therapy are available, such as injection therapy, coagulation therapy, hemostatic clips, argon plasma coagulator, and combination therapy. [40] Injection therapy is performed with epinephrine in a 1:10,000 dilution or with absolute alcohol. Thermal endoscopic therapy is performed with a heater probe, bipolar circumactive probe, or gold probe. Pressure is applied to cause coagulation of the underlying artery (coaptive coagulation). Combination therapy with epinephrine injection followed by thermal coagulation appears to be more effective than monotherapy for ulcers with a visible vessel, active hemorrhage, or adherent clot.

Another study comprising 108 consecutive patients with high-risk bleeding ulcers at a single institution revealed that an injection of epinephrine alone was equally effective as an injection of epinephrine plus fresh frozen plasma in endoscopic hemostasis. [41] There were no significant differences between the groups regarding recurrent bleeding, surgical rate, blood transfusion, or mortality.


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