ENDOSCOPIC HEMOSTASIS FOR BLEEDING PEPTIC -ULCER IN A TEACHING HOSPITAL

Introduction: the results of endoscopic treatment for bleeding peptic ulcers in a teaching hospital are little reported. Most studies are pu blished by a limited number of specialized authors with a reported suc cess rare of 76-83%. The aim of this study is to evaluate the success rate in a teaching hospital. Patients and method: we retrospectively s tudied 150 patients hospitalized in our service between 1994 and 1995, They comprised 59 females (median age 80.5 [24-93] years) and 01 male s (median age 61.5 [26-98]). 49% were aged 70 or over. 39 patients (29 %) had a past history of peptic ulcer disease, the others being admitt ed Cor an initial episode of bleeding ulcer. Biopsies for urease test were obtained in 84 patients. In this group the prevalence of Helicoba cter pylori infection was respectively 88% and 58% in subjects with a history of ulcer disease and in those with an initial episode of bleed ing ulcer. 46% and 54% respectively had taken nonsteroidal anti-inflam matory drugs during the previous weeks. Neither of these two risk fact ors was present in 3 patients without a previous history of ulcer dise ase; they were present in none of those with a history. Results: all p atients underwent emergency esogastroduodenoscopy; 48 underwent endosc opic hemostasis. 12 gastroenterologists were involved in these procedu res. The definitive success rate is 81%. The success rate for a first hemostasis for a posterior bulbar ulcer is 41% vs 88% for the other lo calizations, a difference which is statistically significant (p = 0.00 2). Endoscopic hemostasis showed a higher failure rate where the bleed ing stigmata was a spurting vessel (44% vs 18%) but this was not signi ficant (p = 0.18). Conclusion: endoscopic treatment for bleeding pepti c ulcer is effective in a teaching hospital. The technique shows a hig her failure rate for posterior bulbar ulcers. In view of the risk of r ecurrence, patients should be kept in hospital after a first procedure .