Hydrogen Peroxide Improves the Visibility of Ulcer Bases in Acute Non-variceal Upper Gastrointestinal Bleeding: A Single-Center Prospective Study

BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (ANVB) or hemorrhage (used interchangeably) is an emergency. Endoscopically applied hydrogen peroxide (H(2)O(2)) has been shown to improve visualization of the ulcer base. AIMS: To test the hypothesis that ulcer base clot clearance with 3% H(2)O(2) improves the visualization of ANVB lesions compared to water alone. METHODS: In this single-center prospective study, 320 patients with ANVB were examined, of which 81 met the entry criteria for evaluation. All patients with ANVB underwent urgent endoscopy. Those with adherent clots on the ulcer base were sprayed with 250 ml of water, followed by up to 100 ml of 3% H(2)O(2). The main outcome measurement was Kalloo’s Visual Scores of the ulcer base before and after water and H(2)O(2). RESULTS: Eighty-one patients with gastric ulcers (GU; 34) and duodenal ulcers (DU; 47) met the entry criteria. The mean improvement in grade from water to H(2)O(2) was 2.04 (95% confidence interval [CI] (1.86, 2.23)). The mean volume of H(2)O(2) used to clear clots was higher (70 ml) in patients who were negative for both Helicobacter pylori and non-steroidal anti-inflammatory drug (NSAID) use than in those who were positive for both (31 ml) (P = 0.00). More DU patients (72%) had visible vessels than GU patients (44%) (P = 0.01). CONCLUSIONS: H(2)O(2) improved the visualization of ulcer bases in ANVB. A smaller volume of H(2)O(2) was required to clear clots in patients who used NSAIDs and had H. pylori infection. H(2)O(2) identified more DU vessels. The use of H(2)O(2) should be considered as a standard therapy in the management of clots in ANVB.