EVALUATION OF HEMOSTATIC EFFECT OF TOPICALLY APPLIED THROMBIN ON UPPER GASTROINTESTINAL HEMORRHAGE

Abstract

Hemostatic effect of topically applied thrombin on upper gastrointestinal hemorrhage was evaluated by the combined method of endoscopic spray and oral administration. As a preliminary examination, we endoscopically sprayed bleeding site after gastric biopsy with 10 ml of phosphate buffer solution containing 10, 000 units of thrombin. Bleeding time was significantly reduced by spray of thrombin (58.0±31.5 sec) as compared with phosphate buffer only (138.0±47.5 sec) (P<0.005). Based on these results, thrombin spray technique was applied to eighteen upper gastrointestinal hemorrhagic cases in which obvious bleeding was observed by emergency endoscopic examination. These included thirteen cases of gastric ulcer, two cases of duodenal ulcer, a case of stomal ulcer, esophageal varices and Mallory-Weiss syndrome. Methods were as follows : On the first and second day, endoscopic spray of thrombin was performed as above, followed by oral administration of 20, 000 units of thrombin diluted with phosphate buffer every eight hours, twice a day. On the third day, similar amount of thrombin was given orally every eight hours, thrice a day. Hemostatic effect was determined endoscopically on the fourth day. As a result, hemostatic effect was obtained in 15 of 18 cases (83.3%), which included 13 cases of permanent hemostasis (72.2%) and 2 cases of temporary hemostasis. No effect was observed in 3 cases. In conclusion from our study, it seemed that this method using thrombin was effective on hemostasis in upper gastrointestinal hemorrhagic cases.