Comparison of endoscopic electrocoagulation and laser photocoagulation of bleeding canine gastric ulcers.

The most promising endoscopic hemostatic techniques all depend upon heat to coagulate. Four thermally active techniques under similar controlled conditions in this endoscopic study were compared. The study was undertaken to compare the efficacy and histologic damage of monopolar electrocoagulation (MPEC), bipolar electrocoagulation (BPEC), argon laser photocoagulation (ALP) and neodymium-yytrium-aluminum-garnet (YAG) laser photocoagulation applied endoscopically to control bleeding from standard canine gastric ulcers. An open-closed model utilizing a nontraumatic intestinal clamp in heparinized adult mongrel dogs was used. Bleeding ulcers were randomly assigned to an endoscopic treatment modality or control. The endoscopic techniques and parameters of treatment for this study were established from a previous experience with each modality and from endoscopic treatment in pilot studies. Quantitative efficacy and subjective ease of endoscopic treatment were evaluated acutely; gross and histologic injury were determined after 7 days. Our conclusions were that more energy or greater power was required with each method to treat bleeding standard ulcers efficiently through the endoscope than at laparotomy. It was also concluded that each method was 93% or more effective in halting bleeding in this canine ulcer model but there were differences in ease of endoscopic use. Both lasers were much easier to apply than electrocoagulation. The order of decreasing ease of application was YAG, ALP, MPEC, BPEC. Argon laser and BPEC caused significantly less tissue injury than either MPEC or YAG. The order of increasing injury or decreasing margin of safety was ALP, BPEC, YAG and MPEC. In contrast to electrocoagulation, especially monopolar, laser related tissue injury was generally predictable and correlated with total treatment energy, animal weight or gastric overdistension, or both. The limitations, advantages, and disadvantages of each hemostatic technique are discussed and compared.

[1]  S. Silvis,et al.  Electrocoagulation of hemorrhagic gastritis. , 1971, Gastrointestinal endoscopy.

[2]  J. E. Berk,et al.  Developments in Digestive Diseases-2 , 1979 .

[3]  F. Silverstein,et al.  The multisection tissue slicer: a simpler technique for assessing the maximal depth of experimental injury. , 1979, Gastrointestinal endoscopy.

[4]  P Kiefhaber,et al.  Endoscopical control of massive gastrointestinal hemorrhage by irradiation with a high-power Neodymium-Yag laser. , 1977, Progress in surgery.

[5]  F. Silverstein,et al.  Electrosurgical treatment of experimental bleeding canine gastric ulcers: development and testing of a computer control and a better electrode. , 1978, Gastroenterology.

[6]  J. Petit,et al.  Utilisation d'un laser à argon ionisé en endoscopie digestive : photocoagulation des lésions hémorragiques , 1979 .

[7]  F. Silverstein,et al.  Endoscopic laser treatment. III. Development and testing of a gas-jet-assisted argon laser waveguide in control of bleeding experimental ulcers. , 1978, Gastroenterology.

[8]  F. Silverstein,et al.  Animal endoscopic studies of CO2 assisted argon laser photocoagulation preparatory to controlled trials in man , 1978 .

[9]  F. Silverstein,et al.  Argon vs. neodymium YAG laser photocoagulation of experimental canine gastric ulcers. , 1979, Gastroenterology.

[10]  R. Katon,et al.  Panendoscopy in the early diagnosis of acute upper gastrointestinal bleeding. , 1973, Gastroenterology.

[11]  P. Cotton,et al.  Randomised trial of endoscopic argon laser photocoagulation in bleeding peptic ulcers. , 1981, Gut.

[12]  J. Vennes,et al.  Evaluation of bipolar electrocoagulation in canine stomachs. , 1978, Gastrointestinal endoscopy.

[13]  Papp Jp.  Endoscopic electrocoagulation of actively bleeding arterial upper gastrointestinal lesions. , 1979 .

[14]  L. Demling,et al.  Endoscopic laser coagulation of bleeding gastrointestinal lesions with report of the first therapeutic application in man. , 1976, Gastrointestinal endoscopy.

[15]  W. Gaisford.  Endoscopic electrohemostasis of active upper gastrointestinal bleeding. , 1979, American journal of surgery.

[16]  J. Persing,et al.  The national ASGE survey on upper gastrointestinal bleeding. III. Endoscopy in upper gastrointestinal bleeding. , 1981, Gastrointestinal endoscopy.

[17]  D. Bartlett,et al.  Endoscopic electrocoagulation: an alternative to operative therapy in bleeding peptic ulcer disease. , 1978, Archives of surgery.

[18]  G. W. Snedecor.  Statistical Methods , 1964 .

[19]  C. Lucas,et al.  Electrocoagulation of bleeding in the upper part of the gastrointestinal tract: a preliminary experimental clinical report. , 1975, Archives of surgery.

[20]  J. Elashoff,et al.  YAG laser treatment of experimental bleeding canine gastric ulcers , 1980 .

[21]  J. Elashoff,et al.  Argon laser treatment of bleeding canine gastric ulcers: limitations and guidelines for endoscopic use. , 1981, Gastroenterology.

[22]  F. Silverstein,et al.  Computer-assisted electrocoagulation: Bipolar vs. monopolar in the treatment of experimental canine gastric ulcer bleeding , 1981 .