Retrospective comparison of hot forceps and hemoclip applications in upper gastrointestinal system bleeding

Introduction: Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies encountered by physicians. The annual incidence is 133 per 100,000. Peptic ulcer disease is responsible for 31% to 67% of all cases and is the most common cause of UGIC. In addition, other causes can be listed as variceal bleeding, erosive diseases, Mallory-Weiss tear, Dieulafoy lesions, vascular ectasia and malignancy. Treatment is generally based on acid suppression and the use of endoscopic methods. Endoscopic techniques that can be used in the treatment of UGIB; injection therapy, thermal coagulation therapy, hemostatic clips, fibrin sealant, argon plasma coagulation, and epinephrine injection combined with a different technique. However, there is no clear evidence as to which method is best and should constitute the method of choice. The endoscopist's personal preference, available equipment, location and the characteristics of the lesion play a role in treatment selection. Hemoclip (HC) and thermal therapy, alone or in combination with injection therapy, have been shown to prevent recurrent bleeding and surgical intervention more effectively than injection therapy alone. Endoscopic HC is a mechanical technique frequently used in the treatment of UGIB. This mechanical apparatus provides hemostasis by attaching to the bleeding lesion and peripheral tissue. Thermal treatments provide hemostasis by providing thermal vascular constriction. There are three main types of thermal contact devices; multipolar probes, heating probes and monopolar probes. The low-cost hot forceps (HF) work similarly to the monopolar hemostatic forceps. HF is particularly useful in providing hemostasis in polypectomy and endoscopic submucosal dissection (ESD). In this study, we performed a retrospective comparison of the efficacy and cost-effectiveness of HC and HF in the treatment of UGIB. Material and Method: The study was carried out in Düzce University Training and Research Hospital, Department of Gastroenterology and Internal Medicine; between June 2017 and March 2022. The patients were selected from those who volunteered to participate in the study and a written informed consent form was obtained. During endoscopy, hot forceps or hemoclip applications are routinely applied to patients with upper gastrointestinal bleeding, if necessary. The patients v were divided into two groups according to the endoscopic hemostatic method applied. The HF group was selected from people who underwent hot forceps coagulation, and the HC group was selected from people who underwent hemoclips. Primary hemostasis rates, recurrent bleeding, transfusion requirements, hospital stay and costs were compared between the two groups. All endoscopic procedures. Results: Demographic characteristics of the patients were similar betten the groups. The rates of hypotension and tachycardia in the first 24 hours after the procedure, şaş statistically not significant between the groups. There was no significant difference between the rates of recurrent bleeding in the HC and HF treatment groups. Primary hemostasis rates between HC and HF treatment groups were 83.33% and 87.21%, respectively (p=0,537). In both groups, the average hospitalization time was three days (p=0,206). The cost was higher in the HC group compared to the HF group (p<0,001). Conclusion: This study showed that the relatively newer HF therapy is as safe and effective as HC, as well as being superior to HC in terms of cost effectiveness. In this context, we recommend HF treatment in patients with UGIC in appropriate indications. We believe that our study will shed light on new research on this subject. Keywords: Gastrointestinal bleeding, hot forceps, hemoclips, endoscop