December 17th, 2009
Ulcer Bleeding: Tricks of the Trade!
One of the difficulties we face when performing urgent endoscopy on a patient with upper GI bleeding is to visualize the mucosa and the lesion when blood is still present in the stomach. IV erythromycin can help by evacuating blood from the stomach, but it has become increasingly scarce; we haven’t had any available at my hospital in 6 months. In any case, when we find an ulcer, it is often obscured by an adherent clot, so we don’t know whether a vessel requiring therapy is present within that ulcer.
Now, we have new evidence that another weapon in our bag of tricks can help improve endoscopic visualization of bleeding ulcers, even those hidden by adherent clots. As described recently in Journal Watch Gastroenterology, researchers found that spraying dilute hydrogen peroxide onto blood or clots hydrolyzes hemoglobin and renders it translucent, allowing for improved visualization of underlying lesions.
So I have a couple of questions for you: First, do you have IV erythromycin in stock and, if so, do you administer it to patients with upper GI bleeding before endoscopy? Second, do you plan on keeping hydrogen peroxide on your emergency endoscopy cart and using it to improve visualization of ulcer bases beneath adherent clots?