Adherent Clot: Endoscopic Therapy or Medical Therapy

Adherent clots on peptic ulcers are associated with a high rebleeding rate.

Adherent clot management options include medical therapy alone with proton pump inhibitors (PPIs) or clot removal with or without endoscopic therapy along with PPIs.

Endoscopic therapy involves irrigation for 5 minutes, and if clots do not wash out, options include injecting adrenaline in four corners or cold guillotine of the clot.

However, endoscopic therapy has limitations, including risks such as perforation and inducing more bleeding.

The choice between conventional medical treatment alone or combining it with endoscopic therapy is controversial, but emerging evidence favors endoscopic therapy in high-risk lesions after clot removal.

Newer endoscopic methods like OVESCO may offer advantages, and Doppler can help identify lesions benefi ting from endoscopic therapy.

Expertise in using all modalities is a prerequisite for undertaking these procedures and improving outcomes. Dr Ajay Kumar New Delhi Utility of New Biomarkers in Therapeutic D