Prophylactic Injection Therapy Reduces Recurrent Bleeding In Forrest Type IIb Duodenal Ulcers

NCT ID: NCT01471496

Last Updated: 2011-11-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2003-01-31

Study Completion Date

2009-10-31

Brief Summary

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The purpose of this study is to determine whether prophylactic injection therapy reduces recurrent bleeding rate for duodenal ulcers which has the endoscopic stigmata of recent bleeding.

Detailed Description

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The benefit of endoscopic therapy in ulcers with adherent clots on their surface is still uncertain. A prophylactic injection therapy may reduce the recurrent bleeding rate at this group of patients having this endoscopic stigma of recent bleeding. This type of ulcers are named as type IIb duodenal ulcers according to Forrest's classification, They cary the risk of bleeding recurrence up to 36 percent and as it is reported previously there may be a 12 fold increasement in morbidity and mortality in such cases. A prophylactic endoscopic injection therapy may reduce the risk of recurrent bleeding in this group of the patients.

Conditions

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Duodenal Ulcer Bleeding

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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prophylactic injection therapy group

In addition to medical therapy which included 2x 30 mg Pantoprazole and intravenous fluids this group of the patients recieved injection therapy.

Group Type EXPERIMENTAL

prophylactic injection therapy

Intervention Type PROCEDURE

Standard application of endoscopic injection therapy as it is used for actively bleeding ulcers, 10 ml of serum saline with 1/10000 epinephrine is submucosally injected to the four quadrants of the ulcer margins.

control group

This group of the patients recieved medical therapy only.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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prophylactic injection therapy

Standard application of endoscopic injection therapy as it is used for actively bleeding ulcers, 10 ml of serum saline with 1/10000 epinephrine is submucosally injected to the four quadrants of the ulcer margins.

Intervention Type PROCEDURE

Other Intervention Names

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prophylactic sclerotherapy

Eligibility Criteria

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Inclusion Criteria

* Endoscopic diagnose of Forrest type 2b duodenal ulcer.

Exclusion Criteria

* Patients at whom the onset of Upper Gastrointestinal system bleeding symptoms exceeded 24 hours at index endoscopy.
* Patients having hemodynamic instability: systolic blood pressure below 90 mm/hg, heart rate above 110/min
* Demonstration of hemoglobin fall more than 2 g/dl in two hours.
* Patients with coexisting ulcers elsewhere than in duodenum.
* Patients under anticoagulant therapy other than Aspirin.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Bakirkoy Dr. Sadi Konuk Research and Training Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Osman Z Öner, MD

Role: PRINCIPAL_INVESTIGATOR

Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of General Surgery, Istanbul, Turkey

Locations

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Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of General Surgery

Istanbul, , Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Cheung FK, Lau JY. Management of massive peptic ulcer bleeding. Gastroenterol Clin North Am. 2009 Jun;38(2):231-43. doi: 10.1016/j.gtc.2009.03.003.

Reference Type BACKGROUND
PMID: 19446256 (View on PubMed)

Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G. An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium. Gastrointest Endosc. 2008 Mar;67(3):422-9. doi: 10.1016/j.gie.2007.09.024. Epub 2008 Jan 18.

Reference Type BACKGROUND
PMID: 18206878 (View on PubMed)

Yavorski RT, Wong RK, Maydonovitch C, Battin LS, Furnia A, Amundson DE. Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am J Gastroenterol. 1995 Apr;90(4):568-73.

Reference Type BACKGROUND
PMID: 7717312 (View on PubMed)

Pilotto A, Maggi S, Noale M, Franceschi M, Parisi G, Crepaldi G; IPOD Investigators. Development and validation of a new questionnaire for the evaluation of upper gastrointestinal symptoms in the elderly population: a multicenter study. J Gerontol A Biol Sci Med Sci. 2010 Feb;65(2):174-8. doi: 10.1093/gerona/glp073. Epub 2009 Jun 15.

Reference Type BACKGROUND
PMID: 19528359 (View on PubMed)

Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am. 2008 May;92(3):491-509, xi. doi: 10.1016/j.mcna.2008.01.005.

Reference Type BACKGROUND
PMID: 18387374 (View on PubMed)

Kovacs TO. Management of upper gastrointestinal bleeding. Curr Gastroenterol Rep. 2008 Dec;10(6):535-42. doi: 10.1007/s11894-008-0099-3.

Reference Type BACKGROUND
PMID: 19006607 (View on PubMed)

Kubba AK, Palmer KR. Role of endoscopic injection therapy in the treatment of bleeding peptic ulcer. Br J Surg. 1996 Apr;83(4):461-8. doi: 10.1002/bjs.1800830408.

Reference Type BACKGROUND
PMID: 8665233 (View on PubMed)

Chung SC, Leung JW, Leung FW. Effect of submucosal epinephrine injection on local gastric blood flow. A study using laser Doppler flowmetry and reflectance spectrophotometry. Dig Dis Sci. 1990 Aug;35(8):1008-11. doi: 10.1007/BF01537250.

Reference Type BACKGROUND
PMID: 2384031 (View on PubMed)

Calvet X, Vergara M, Brullet E, Gisbert JP, Campo R. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology. 2004 Feb;126(2):441-50. doi: 10.1053/j.gastro.2003.11.006.

Reference Type BACKGROUND
PMID: 14762781 (View on PubMed)

Green FW Jr, Kaplan MM, Curtis LE, Levine PH. Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor prolonged gastroduodenal mucosal hemorrhage. Gastroenterology. 1978 Jan;74(1):38-43.

Reference Type BACKGROUND
PMID: 21830 (View on PubMed)

Heldwein W, Schreiner J, Pedrazzoli J, Lehnert P. Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers? Endoscopy. 1989 Nov;21(6):258-62. doi: 10.1055/s-2007-1010729.

Reference Type BACKGROUND
PMID: 2693077 (View on PubMed)

Ferguson CB, Mitchell RM. Non-variceal upper gastrointestinal bleeding. Ulster Med J. 2006 Jan;75(1):32-9. No abstract available.

Reference Type BACKGROUND
PMID: 16457402 (View on PubMed)

Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974 Aug 17;2(7877):394-7. doi: 10.1016/s0140-6736(74)91770-x. No abstract available.

Reference Type BACKGROUND
PMID: 4136718 (View on PubMed)

Peter S, Wilcox CM. Modern endoscopic therapy of peptic ulcer bleeding. Dig Dis. 2008;26(4):291-9. doi: 10.1159/000177011. Epub 2009 Jan 30.

Reference Type BACKGROUND
PMID: 19188717 (View on PubMed)

Armstrong CP, Blower AL. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration. Gut. 1987 May;28(5):527-32. doi: 10.1136/gut.28.5.527.

Reference Type BACKGROUND
PMID: 3596334 (View on PubMed)

Balanzo J, Sainz S, Such J, Espinos JC, Guarner C, Cusso X, Mones J, Vilardell F. Endoscopic hemostasis by local injection of epinephrine and polidocanol in bleeding ulcer. A prospective randomized trial. Endoscopy. 1988 Nov;20(6):289-91. doi: 10.1055/s-2007-1013023.

Reference Type BACKGROUND
PMID: 3068050 (View on PubMed)

Buffoli F, Graffeo M, Nicosia F, Gentile C, Cesari P, Rolfi F, Paterlini A. Peptic ulcer bleeding: comparison of two hemostatic procedures. Am J Gastroenterol. 2001 Jan;96(1):89-94. doi: 10.1111/j.1572-0241.2001.03456.x.

Reference Type BACKGROUND
PMID: 11197294 (View on PubMed)

Hui WM, Ng MM, Lok AS, Lai CL, Lau YN, Lam SK. A randomized comparative study of laser photocoagulation, heater probe, and bipolar electrocoagulation in the treatment of actively bleeding ulcers. Gastrointest Endosc. 1991 May-Jun;37(3):299-304. doi: 10.1016/s0016-5107(91)70719-0.

Reference Type BACKGROUND
PMID: 2070978 (View on PubMed)

Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology. 1992 Jan;102(1):139-48. doi: 10.1016/0016-5085(92)91793-4.

Reference Type BACKGROUND
PMID: 1530782 (View on PubMed)

Branicki FJ, Coleman SY, Fok PJ, Pritchett CJ, Fan ST, Lai EC, Mok FP, Cheung WL, Lau PW, Tuen HH, et al. Bleeding peptic ulcer: a prospective evaluation of risk factors for rebleeding and mortality. World J Surg. 1990 Mar-Apr;14(2):262-9; discussion 269-70. doi: 10.1007/BF01664889.

Reference Type BACKGROUND
PMID: 2327100 (View on PubMed)

Cooper GS, Chak A, Way LE, Hammar PJ, Harper DL, Rosenthal GE. Early endoscopy in upper gastrointestinal hemorrhage: associations with recurrent bleeding, surgery, and length of hospital stay. Gastrointest Endosc. 1999 Feb;49(2):145-52. doi: 10.1016/s0016-5107(99)70478-5.

Reference Type BACKGROUND
PMID: 9925690 (View on PubMed)

Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol. 2009 Jan;7(1):33-47; quiz 1-2. doi: 10.1016/j.cgh.2008.08.016. Epub 2008 Aug 16.

Reference Type BACKGROUND
PMID: 18986845 (View on PubMed)

Kahi CJ, Jensen DM, Sung JJ, Bleau BL, Jung HK, Eckert G, Imperiale TF. Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology. 2005 Sep;129(3):855-62. doi: 10.1053/j.gastro.2005.06.070.

Reference Type BACKGROUND
PMID: 16143125 (View on PubMed)

Marmo R, Rotondano G, Bianco MA, Piscopo R, Prisco A, Cipolletta L. Outcome of endoscopic treatment for peptic ulcer bleeding: Is a second look necessary? A meta-analysis. Gastrointest Endosc. 2003 Jan;57(1):62-7. doi: 10.1067/mge.2003.48.

Reference Type BACKGROUND
PMID: 12518133 (View on PubMed)

Laine L, Stein C, Sharma V. A prospective outcome study of patients with clot in an ulcer and the effect of irrigation. Gastrointest Endosc. 1996 Feb;43(2 Pt 1):107-10. doi: 10.1016/s0016-5107(06)80109-4.

Reference Type BACKGROUND
PMID: 8635701 (View on PubMed)

Other Identifiers

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konuk-001

Identifier Type: -

Identifier Source: org_study_id