Evaluation of endoscopic hemostasis with metallic hemoclips for bleeding gastric ulcer: comparison with endoscopic injection of absolute ethanol in a prospective, randomized study

Am J Gastroenterol. 2003 Oct;98(10):2198-202. doi: 10.1111/j.1572-0241.2003.07692.x.


Objective: Although metallic hemoclips have been used for hemostasis of bleeding ulcer, there have been few prospective trials to evaluate their efficacy. In this study, a prospective, randomized trial was performed to evaluate endoscopic hemoclipping for bleeding gastric ulcer in comparison with endoscopic injection of absolute ethanol.

Methods: During the period 1995-1998, 126 gastric ulcer patients with bleeding or nonbleeding visible vessel were considered for entry. They were randomly assigned to one of three groups: endoscopic hemostasis performed with injection of absolute ethanol (group I, n = 42), hemoclipping (group II, n = 42), and a combination of the two methods (group III, n = 42).

Results: The permanent hemostatic rate was 85.7% in group I, 90.5% in group II, and 92.9% in group III. The mean volume of blood transfusion was 313 +/- 77 ml in group I, 274 +/- 54 ml in group II, and 163 +/- 42 ml in group III, which was significantly less than in groups I or II (p < 0.05). No patients required emergency surgery. Five patients died within a month after initial hemostasis as a result of unrelated conditions.

Conclusions: Endoscopic hemostasis with hemoclips for bleeding gastric ulcer was as effective and safe as that with injection of absolute ethanol, and a combination of ethanol injection and hemoclips did not result in a great advantage over the two individual procedures.

Publication types

  • Clinical Trial
  • Comparative Study
  • Evaluation Study
  • Randomized Controlled Trial

MeSH terms

  • Equipment Design
  • Ethanol / administration & dosage*
  • Female
  • Follow-Up Studies
  • Hemostasis, Endoscopic / instrumentation*
  • Hemostasis, Endoscopic / methods
  • Humans
  • Injections, Intralesional
  • Male
  • Metals
  • Middle Aged
  • Peptic Ulcer Hemorrhage / diagnosis
  • Peptic Ulcer Hemorrhage / therapy*
  • Prospective Studies
  • Reference Values
  • Sclerosing Solutions / therapeutic use
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Stomach Ulcer / diagnosis
  • Stomach Ulcer / therapy*
  • Surgical Instruments
  • Treatment Outcome


  • Metals
  • Sclerosing Solutions
  • Ethanol