LIMITATIONS OF ENDOSCOPIC HEMOSTASIS BY ETHANOL INJECTION AND SURGICAL-MANAGEMENT FOR BLEEDING PEPTIC-ULCER

Two hundred and fifty-three patients with bleeding peptic ulcer underw ent therapeutic endoscopy using local ethanol injection and were evalu ated to determine the need for surgery and outcome. Permanent endoscop ic haemostasis was achieved in 178 (70.4%) cases. Pulsatile arterial b leeding in ulcers and shock on admission (respectively, P < 0.01, P < 0.05) were significantly more frequent in patients with unsuccessful e ndoscopic treatment. Postoperative stay was significantly longer (P < 0.05) for patients with bleeding peptic ulcer than for patients requir ing surgery for intractable ulcer without bleeding. Surgery was recomm ended if three attempts at endoscopic treatment did not achieve perman ent haemostasis. The need for more than three such treatment sessions and the presence of a large excavated ulcer with an exposed vessel in an elderly patient were considered to indicate the necessity for surge ry. Surgical procedures to which the operator is accustomed and intens ive management were recommended for emergency cases to optimize the li kelihood of survival.