EurekaMag.com logo
+ Site Statistics
References:
53,869,633
Abstracts:
29,686,251
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on LinkedInFollow on LinkedIn

+ Translate

Laser photocoagulation for the treatment of acute peptic-ulcer bleeding. A randomized controlled clinical trial



Laser photocoagulation for the treatment of acute peptic-ulcer bleeding. A randomized controlled clinical trial



New England Journal of Medicine 316(26): 1618-1621



We tested the hypothesis that therapeutic endoscopy using the Nd:YAG (neodymium:yttrium-aluminum-garnet) laser would benefit patients with acute peptic-ulcer bleeding. Over 43 months, 174 patients with active bleeding (n = 32) or stigmata of recent bleeding (n = 142) due to peptic ulcers were randomly assigned during endoscopy to either standard treatment with laser photocoagulation or therapy without photocoagulation. There were no significant differences in a number of outcomes between the group treated with laser photocoagulation and the control group. Continued bleeding or rebleeding was observed in 22 percent of the laser-treated group and in 20 percent of the control group. Urgent surgery was necessary in 16 percent of the laser-treated patients and in 17 percent of the controls. Laser-treated patients spent a mean of 41 hours in the intensive care unit, and controls spent a mean of 32 hours. The mean hospital stay was 12 days in the laser-treated group and 11 days in the control group. One death occurred in each group. When patients with active bleeding were analyzed separately, there was no significant difference in outcome, even though laser photocoagulation stopped active bleeding in 88 percent of cases. Among patients with visible vessels, rebleeding occurred in 5 of 14 (36 percent) who received laser treatment and 2 of 15 (13 percent) who did not. Laser treatment precipitated bleeding in four patients and duodenal perforation in one. We conclude that Nd:YAG-laser photocoagulation does not benefit patients with acute upper gastrointestinal bleeding from peptic ulcers.

(PDF emailed within 0-6 h: $19.90)

Accession: 040553270

Download citation: RISBibTeXText

PMID: 3295548

DOI: 10.1056/NEJM198706253162602



Related references

Laser photocoagulation for the treatment of the acute peptic ulcer bleeding a randomized controlled clinical trial. Gastroenterology 88(5 PART 2): 1457, 1985

Injection of fibrin tissue adhesive versus laser photocoagulation in the treatment of high-risk bleeding peptic ulcers: a controlled randomized study. Gastrointestinal Endoscopy 46(2): 198-199, 1997

Controlled trial of Nd-YAG laser photocoagulation in bleeding peptic ulcers. Lancet 1(8490): 1113-1117, 1986

Controlled trial of neodymium yag laser photocoagulation in bleeding peptic ulcers. Lancet 1(8490): 1113-1117, 1986

Controlled trial of argon laser photocoagulation in bleeding peptic ulcers. Lancet 2(8259): 1313-1316, 1981

Randomized trial of adrenaline injection and laser photocoagulation in the control of haemorrhage from peptic ulcer. British Journal of Surgery 81(6): 869-871, 1994

Pantoprazole infusion as adjuvant therapy to endoscopic treatment in patients with peptic ulcer bleeding: prospective randomized controlled trial. Journal of Gastroenterology and Hepatology 21(4): 716-721, 2006

Oral proton pump inhibitors are as effective as endoscopic treatment for bleeding peptic ulcer: a prospective, randomized, controlled trial. Digestive Diseases and Sciences 52(12): 3371-3376, 2007

Randomized controlled trial of standard versus high-dose intravenous omeprazole after endoscopic therapy in high-risk patients with acute peptic ulcer bleeding. British Journal of Surgery 98(5): 640-644, 2011

A randomized controlled trial comparing two different dosages of infusional pantoprazole in peptic ulcer bleeding. British Journal of Clinical Pharmacology 69(3): 245-251, 2010

Controlled clinical trial of ranitidine in bleeding peptic ulcer. Australian & New Zealand Journal of Surgery 56(9): 723-728, 1986

Somatostatin inhibits gastric acid secretion more effectively than pantoprazole in patients with peptic ulcer bleeding: a prospective, randomized, placebo-controlled trial. Scandinavian Journal of Gastroenterology 40(5): 515-522, 2005

Topical tranexamic acid as a novel treatment for bleeding peptic ulcer: A randomised controlled trial. African Journal of Paediatric Surgery 13(1): 9-13, 2016

Therapeutic endoscopy of bleeding peptic ulcer the value of a second look endoscopy a randomized controlled trial. Gastroenterology 102(4 PART 2): A185, 1992

Laser induced intravascular coagulation for the treatment of acute peptic ulcer bleeding. British Journal of Surgery 75(5): 497-497, 1988