Which Hemostatic Techniques Should Be Used for Ulcer Hemorrhage?
We recommend combination therapy with epinephrine injection and a thermal probe, particularly for active arterial bleeding and adherent clots8 because this therapy combines different mechanisms of arterial -hemostasis such as vasoconstriction, activation of platelet coagulation, and coaptive coagulation. Epinephrine injection may be with a standard sclerotherapy catheter or a combination device. The injector Gold probe reduces the treatment time compared to 2 separate catheters in laboratory and clinical settings. Two groups of investigators have reported significantly better results with combination therapy (epinephrine and thermal probe) than monotherapy for active arterial bleeding. In contrast, combination therapy compared to epinephrine injection alone did not improve outcomes of patients with oozing ulcer bleeding in one large study. Successful endoscopic hemostasis is achieved in nearly 100% of patients with combination therapy for treatment of chronic-appearing ulcers with acti
