What's the Best Approach for Bleeding Ulcers with Adherent Clots?

Endoscopic therapy for bleeding peptic ulcers with visible vessels (active bleeding or nonbleeding) improves morbidity, mortality, and other outcomes. However, the best approach for ulcers with bases that are obscured by adherent clots resistant to vigorous flushing is controversial: Study results have been varied as to whether clot removal and treatment of underlying lesions or observation alone is best. To resolve this question, investigators in this multicenter study randomized 56 patients with acute upper gastrointestinal bleeding from peptic ulcers with adherent clots and no active bleeding to receive endoscopic therapy or medical management.

Patients assigned to endoscopic therapy received epinephrine injections (1:10,000 epinephrine) …