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112 ENDOSCOPIC INJECTION PLUS CONTINUOUS INTRAVENOUS PANTOPRAZOLE VS ENDOSCOPIC INJECTION PLUS CONTINUOUS INTRAVENOUS OMEPRAZOLE FOR THE TREATMENT OF UPPER NONVARICEAL BLEEDING NJ Chahin1, M Meli2, F Zaca3 AIMS: Endoscopic hemostasis of high-risk ulcers can control bleeding and reduce rebleeding rate, morbidity and even mortality, but additional medical therapy may improve its benefit. Hemostasis is highly pH dependent and is severely impaired at low pH. The aim of the study was to investigate whether a proton pump inhibitor (pantoprazole), by achieving a significantly higher inhibition of acid secretion, may improve the therapeutic outcomes after endoscopic hemostasis.
1Chief of Gastroenterology and Digestive Endoscopy Unit, 2Unit of Intensive Care, 3Unit of Cardiology, Hesperia Hospital, Modena, Italy
METHODS: In this study, 164 patients with endoscopically confirmed bleeding from gastric, duodenal, stomal peptic ulcers, oesophagitis, Dieulafoy's lesions and stigmata of recent bleeding were included; 28 patients with arterial spurting, 42 patients with active oozing, 46 patients with visible vessel and 48 with adherent clot. All bleeders were treated with endoscopic injection using 1:10000 adrenaline (range 8 mL to 15 mL) and were randomly assigned to receive within two hours pantoprazole (80 mg bolus followed by continuous intravenous infusion 8 mg/h for three days) or omeprazole (80 mg bolus followed by continuous intravenous infusion 8 mg/h for three days). The outcome criteria were rebleeding, blood transfusion, hospital stay and surgery.
RESULTS: Three (3.7%) of 81 patients of the pantoprazole group had re-bleeding, as compared with nine (10.2%) of the omeprazole group (P=0.022). One patient in the pantoprazole group and four in the omeprazole group underwent surgery for uncontrolled bleeding (P=0.16). One patient in the pantoprazole group and two patients in the omeprazole group died (P=0.1). Twenty patients (25%) in the pantoprazole group and 42 patients (50%) in the omeprazole group received blood transfusion (P<0.001). The mean hospital stay was 4.6±1.2 days in the pantoprazole group and 7.1±0.8 days in the omeprazole group (P<0.001).
CONCLUSIONS: Endoscopic haemostasis combined with intravenous pantoprazole is more efficacious than endoscopic haemostasis combined with intravenous omeprazole in reducing rebleeding rate, need of surgery, blood transfusion and hospital stay in patients with nonvariceal bleeding.