ENDOSCOPIC INJECTION TREATMENT OF GASTROINTESTINAL-BLEEDING IN HEMOPHILIACS

The aims of this prospective study were to determine the patterns of g astrointestinal (GI) bleeding in hemophiliacs and to access the hemost atic effect of injection therapy with alcohol. During a 5-year period (1990-1994) 89 hemophiliacs were admitted to our department with acute GI bleeding. Among these patients duodenal ulcer was found endoscopic ally to be the most common (42.7%) cause of hemorrhage; gastric ulcer was the source of the bleeding in only three patients (3.4%). A group of 46 patients met the criteria of active or recent bleeding and under went injection therapy with alcohol. The injected bleeding lesions wer e duodenal ulcer in 32 patients, duodenal erosion in 2, gastric ulcer in 3, and other gastric lesions (Mallory-Weiss tear, Dieulafoy lesion, stomal ulcer, erosions) in 9 patients. Initial hemostasis was achieve d in 100% and permanent hemostasis in 82.6%. Rebleeding was observed i n eight patients (17.4%), with five of them successfully treated by re injections. Three patients (6.5%) required emergency surgery. The mort ality rate in the group of injected patients was 2.2%. One patient die d of stroke on day 10 after partial gastrectomy. All injected patients were given replacement therapy with factor VIII or IX for 2 days (29 patients) or 7 to 14 days (17 patients). Analysis of the hemostatic ef fect achieved in these two subgroups indicate that short-term replacem ent therapy (2 days) may be sufficient to ensure adequate hemostasis i n hemophiliacs. The results of the present study indicate the injectio n therapy with alcohol is an effective, safe, proved method to control GI bleeding in hemophiliacs.