ROLE OF ENDOSCOPIC INJECTION THERAPY IN THE TREATMENT OF BLEEDING PEPTIC-ULCER

Of patients with peptic ulceration who are actively bleeding at endosc opy, 80 per cent will continue to bleed or rebleed in hospital; 50 per cent of those who have a non-bleeding visible vessel will also reblee d. Endoscopic injection treatment stops active bleeding and prevents f urther haemorrhage in most of these patients. The mechanism of action may include tamponade, vasoconstriction, sclerosis, tissue dehydration and thrombogenesis; substances injected include adrenaline, sclerosan ts, alcohol, thrombin, or a combination of agents. Although trials oft en define the need for surgery as an injection treatment failure, an a lternative view is that endoscopic control may facilitate safe, early, elective surgery. A successful outcome may require a combination of e ndoscopic and operative approaches.