UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Contact thermal devices for the treatment of bleeding peptic ulcers

Author
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

The treatment of bleeding peptic ulcers includes resuscitation, treatment with acid suppressive therapy, and application of endoscopic therapy for patients at high risk of ongoing or recurrent bleeding (table 1). Several endoscopic approaches can be used to treat bleeding peptic ulcers, including use of contact thermal devices, endoscopic hemoclips, and epinephrine injection.

This topic will review the use of contact thermal devices for the treatment of bleeding peptic ulcers. An overview of the treatment of bleeding peptic ulcers, issues to consider when deciding which specific endoscopic therapies to use, and treating bleeding ulcers with endoscopic hemoclips, epinephrine injection, or argon plasma coagulation are discussed elsewhere. (See "Approach to acute upper gastrointestinal bleeding in adults" and "Overview of the treatment of bleeding peptic ulcers" and "Endoclip therapy in the gastrointestinal tract: Bleeding lesions and beyond", section on 'Bleeding peptic ulcers' and "Argon plasma coagulation in the management of gastrointestinal hemorrhage".)

INDICATIONS

Contact thermal therapy is one option for treating ulcers with stigmata of recent hemorrhage (table 2) [1]. It can also be used to treat patients with bleeding from Dieulafoy's lesions, Mallory-Weiss tears, and gastric antral vascular ectasias. (See "Overview of the treatment of bleeding peptic ulcers", section on 'Endoscopic therapy' and "Causes of upper gastrointestinal bleeding in adults", section on 'Specific causes'.)

The appearance of ulcers can be described using the Forrest classification [2]:

Class Ia – Spurting hemorrhage (picture 1 and movie 1)

                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Jan 13 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Katschinski B, Logan R, Davies J, et al. Prognostic factors in upper gastrointestinal bleeding. Dig Dis Sci 1994; 39:706.
  2. Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974; 2:394.
  3. Asge Technology Committee, Conway JD, Adler DG, et al. Endoscopic hemostatic devices. Gastrointest Endosc 2009; 69:987.
  4. Saltzman JR, Thiesen A, Liu JJ. Determination of optimal monopolar coagulation settings for upper GI bleeding in a pig model. Gastrointest Endosc 2010; 72:796.
  5. Nunoue T, Takenaka R, Hori K, et al. A Randomized Trial of Monopolar Soft-mode Coagulation Versus Heater Probe Thermocoagulation for Peptic Ulcer Bleeding. J Clin Gastroenterol 2015; 49:472.
  6. Peng YC, Chen SW, Tung CF, et al. Comparison the efficacy of intermediate dose argon plasma coagulation versus hemoclip for upper gastrointestinal non-variceal bleeding. Hepatogastroenterology 2013; 60:2004.
  7. Yamasaki Y, Takenaka R, Nunoue T, et al. Monopolar soft-mode coagulation using hemostatic forceps for peptic ulcer bleeding. Hepatogastroenterology 2014; 61:2272.
  8. Hui WM, Ng MM, Lok AS, et al. A randomized comparative study of laser photocoagulation, heater probe, and bipolar electrocoagulation in the treatment of actively bleeding ulcers. Gastrointest Endosc 1991; 37:299.
  9. Lin HJ, Wang K, Perng CL, et al. Heater probe thermocoagulation and multipolar electrocoagulation for arrest of peptic ulcer bleeding. A prospective, randomized comparative trial. J Clin Gastroenterol 1995; 21:99.
  10. Wong RC. Endoscopic Doppler US probe for acute peptic ulcer hemorrhage. Gastrointest Endosc 2004; 60:804.
  11. Jensen D, Ohning G, Singh B, et al. For severe UGI hemorrhage doppler ultrasound probe is more accurate for risk stratification and helpful for complete endoscopic hemostasis than lesion stigmata alone. Gastrointest Endosc 2008; 67:AB81:264.
  12. Jensen DM, Ohning GV, Kovacs TO, et al. Doppler endoscopic probe as a guide to risk stratification and definitive hemostasis of peptic ulcer bleeding. Gastrointest Endosc 2016; 83:129.
  13. Llach J, Bordas JM, Salmerón JM, et al. A prospective randomized trial of heater probe thermocoagulation versus injection therapy in peptic ulcer hemorrhage. Gastrointest Endosc 1996; 43:117.
  14. Morris ML, Tucker RD, Baron TH, Song LM. Electrosurgery in gastrointestinal endoscopy: principles to practice. Am J Gastroenterol 2009; 104:1563.
  15. Jensen DM. Thermal probe or combination therapy for non-variceal UGI hemorrhage. Techniques in Gastrointestinal Endoscopy 1999; 1:107.
  16. Jensen DM. Where next with endoscopic ulcer hemostasis? Am J Gastroenterol 2002; 97:2161.
  17. Jensen DM, Machicado GA. Endoscopic Hemostasis of Ulcer Hemorrhage with Injection, Thermal, or Combination Methods. Techniques in Gastrointestinal Endoscopy 2005; 7:124.
  18. Sung JJ, Barkun A, Kuipers EJ, et al. Intravenous esomeprazole for prevention of recurrent peptic ulcer bleeding: a randomized trial. Ann Intern Med 2009; 150:455.
  19. Jensen DM, Kovacs TO, Jutabha R, et al. Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 2002; 123:407.
  20. Bleau BL, Gostout CJ, Sherman KE, et al. Recurrent bleeding from peptic ulcer associated with adherent clot: a randomized study comparing endoscopic treatment with medical therapy. Gastrointest Endosc 2002; 56:1.
  21. Kahi CJ, Jensen DM, Sung JJ, et al. Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology 2005; 129:855.
  22. 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; 43:107.
  23. Kalloo AN, Canto MI, Wadwa KS, et al. Clinical usefulness of 3% hydrogen peroxide in acute upper GI bleeding: a pilot study. Gastrointest Endosc 1999; 49:518.
  24. Wu DC, Lu CY, Lu CH, et al. Endoscopic hydrogen peroxide spray may facilitate localization of the bleeding site in acute upper gastrointestinal bleeding. Endoscopy 1999; 31:237.
  25. Sridhar S, Chamberlain S, Thiruvaiyaru D, et al. Hydrogen peroxide improves the visibility of ulcer bases in acute non-variceal upper gastrointestinal bleeding: a single-center prospective study. Dig Dis Sci 2009; 54:2427.
  26. Chung SS, Lau JY, Sung JJ, et al. Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. BMJ 1997; 314:1307.
  27. Lin HJ, Tseng GY, Perng CL, et al. Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding. Gut 1999; 44:715.
  28. Fullarton GM, Birnie GG, Macdonald A, Murray WR. Controlled trial of heater probe treatment in bleeding peptic ulcers. Br J Surg 1989; 76:541.
  29. Jaramillo JL, Carmona C, Gálvez C, et al. Efficacy of the heater probe in peptic ulcer with a non-bleeding visible vessel. A controlled, randomised study. Gut 1993; 34:1502.
  30. Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. A prospective controlled trial. N Engl J Med 1987; 316:1613.
  31. Laine L. Multipolar electrocoagulation in the treatment of peptic ulcers with nonbleeding visible vessels. A prospective, controlled trial. Ann Intern Med 1989; 110:510.
  32. Tekant Y, Goh P, Alexander DJ, et al. Combination therapy using adrenaline and heater probe to reduce rebleeding in patients with peptic ulcer haemorrhage: a prospective randomized trial. Br J Surg 1995; 82:223.
  33. Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992; 102:139.
  34. Chung SC, Leung JW, Sung JY, et al. Injection or heat probe for bleeding ulcer. Gastroenterology 1991; 100:33.
  35. Matthewson K, Swain CP, Bland M, et al. Randomized comparison of Nd YAG laser, heater probe, and no endoscopic therapy for bleeding peptic ulcers. Gastroenterology 1990; 98:1239.