[Acute ulcer hemorrhage: when to operate--when to wait?]

The identification of prognostic factors in patients with bleeding peptic ulcer is an essential step for improving the outcome. Since recurrence of bleeding is associated with increased mortality, we therefore developed a new treatment policy based on prognostic information identified at emergency endoscopy. Patients with actively bleeding lesions or visible vessel and high risk of recurrent bleeding were operated upon within 6 h (duodenal ulcer) or 24 h (gastric ulcer) even after successful endoscopic control of bleeding. All other patients with oozing type of bleeding or with signs of recent bleeding during emergency endoscopy were primarily treated in a conservative manner. By using this strategy in a prospective trial the overall mortality rate could be markedly reduced from 14 to 5%.