SUCCESS OF ENDOSCOPIC INJECTION THERAPY IN CORRELATION WITH MAXIMAL ONE-DAY TRANSFUSION REQUIREMENT

Background and Study Aims: The rate of blood transfusion is related to blood flow and the diameter of the bleeding vessel, Therapeutic endos copy is less effective in larger vessels, To determine the effect of t herapeutic endoscopy with pure ethanol injection in massive peptic ulc er bleeding, we conducted a retrospective study using the maximal one- day blood requirement as an indicator of the required blood transfusio n. Patients and Methods: The maximal one-day blood requirement was def ined as the total amount of blood transfusion needed within a day to k eep hemodynamics stable and hemoglobin above 8.0 g% before therapeutic endoscopy, From January 1986 to May 1993, 283 patients with high-risk signs of the stigmata of hemorrhage on endoscopy, who received pure e thanol injection therapy, were included in this study, There were 214 men and 69 women with a mean age of 58.4 years (ranging from 16 to 93 years), One hundred forty-three had gastric ulcers; 125 had duodenal u lcers; and 15 had stomal ulcers. Patients whose maximal one-day blood requirement was less than 1000 ml were assigned to Group I. Patients w ithout, and patients with, major organ diseases whose maximal one-day blood requirement was more than 1000 ml were assigned to Group IIa and Group IIb, respectively. Results: In Group I, 87.1% attained permanen t hemostasis; 51.3% in Group IIa; and 49.4% in Group IIb, Temporary he mostasis and failure rates were 8.9% and 4.8% in Group I; 14.5% and 33 .8% in Group IIa; and 21.2% and 29.4% in Group IIb The rate of permane nt hemostasis was significantly lower in patients with massive bleedin g (p < 0.001) but did not differ between patients with and without maj or organ diseases (p > 0.05). Conclusion: The success rate for pure et hanol injection therapy was lower in patients with a large maximal one -day blood transfusion requirement.