Comparison of Endoscopic Hot Biopsy Forceps Coagulation and Hemostatic Clips for High-Risk Bleeding Peptic Ulcers

BACKGROUND Acute upper gastrointestinal bleeding (AUGIB) remains a major clinical emergency with significant morbidity and mortality, with peptic ulcers being the predominant etiology. Optimizing endoscopic hemostatic strategies for high-risk bleeding ulcers is therefore of critical importance. METHODS This retrospective study evaluated 58 patients with bleeding peptic ulcers classified as Forrest Ia, Ib, IIa, and IIb, who underwent endoscopic hemostasis between 2019 and 2024. Of these, 35 patients received hot biopsy forceps coagulation (Group A), while 23 were treated with hemostatic clips placement (Group B). Clinical outcomes including primary hemostasis success and 7-day rebleeding rates were analyzed. RESULTS The results showed that there was no statistically significant difference (P > 0.05) between the two groups in the success rate of first hemostasis (91.43% vs. 82.61%) and the 7-day rebleeding rate (12.50% vs. 0%), but subgroup analyses revealed a critical threshold effect: for ≥ 1 cm ulcers, the success rate of hemostasis in the hot biopsy forceps coagulation-hemostasis group was significantly superior to that of hemostatic clips (88.24% vs. 33.33%, P = 0.0212), while both reached high efficiency in the < 1cm group (94.44% vs. 100%). Further analysis showed that hot biopsy forceps electrocoagulation hemostasis failure was significantly correlated with bleeding vessel diameter ≥ 2.2mm (4.0mm vs. 2.19mm, P = 0.042), while hemostatic clips failure was positively correlated with ulcer size (1.125cm vs. 0.616cm, P = 0.003). CONCLUSION Hot biopsy forceps coagulation offers a cost-effective and efficient option for managing bleeding ulcers ≥ 1 cm or those involving large-caliber vessels (≤ 2.2mm). Ulcer diameter of 1 cm and vessel diameter of 2.2mm may serve as critical thresholds for stratifying endoscopic hemostatic approaches, providing a foundation for individualized, evidence-based treatment strategies.