Controlled studies of laser therapy for haemorrhage from peptic ulcers

Most episodes of haemorrhage from peptic ulcers cease spontaneously. A controlled trial designed to assess the efficacy of a new endoscopic treatment must answer 3 questions: Since 1981, 8 controlled trials have been reported of endoscopic laser therapy for haemorrhage from peptic ulcers. The protocols and conclusions varied, but when analysed in the same way, the results from all are consistent with each other. Further heamorrhage is most likely in ulcers with a visible vessel (bleeding or non-bleeding) seen in the crater at emergency endoscopy. About 75 % of rebleeds occur in ulcers accessible to laser therapy. Both Argon and Nd YAG lasers can reduce the incidence of rebleeding in ulcers with accessible visible vessels, but the results with the Nd YAG laser are more convincing. The most recent trial with the Nd YAG laser showed a significant reduction in rebleeding (p < 0.001), emergency surgery (p < 0.005) and mortality (p < 0.05). Few comparable trials have been reported with non-laser techniques although experimental studies with monopolar, bipolar and liquid electrodes and the heater probe are encouraging. Clinical trials to compare these with lasers are under way.