However, it is important to emphasize that endoscopy is not an accurate way of distinguishing ulcers from erosions. There is no consensus as to which endoscopic technique is most effective in active spurting. Probably the skill of the endoscopist in applying the technique is more important than the choice of technique. Sodium morrhuate is widely used to inject esophageal varices, but has only rarely been advocated for ulcers. Some authorities have advocated first injecting epinephrine to cause vasoconstriction and then, polidocanol to produce sclerosis.12 Others have suggested, on the basis of data obtained from an animal model, that hemostasis depends more on the volume of solution injected than the agent that is used.
Heat is produced by a silicone chip in the tip of the probe, which then conducts heat to tissue.
An analogue computer ensures that the temperature at the tip never rises above 250oC to avoid severe tissue damage. The endoscopist controls the amount of energy delivered to the tissue by selecting anywhere from 5 to 30 joules of energy. Then a foot pedal is pressed to fire the probe. Even with the use of such pressure, perforation has been reported only rarely. However, mortality was statistically decreased only in some trials.