Bleeding gastric and duodenal ulcers: endoscopic therapy versus surgery

From a retrospective review of 156 patients with actively bleeding peptic ulcers, 61 patients had gastric ulcers and 95 patients had duodenal ulcers. Patients presented with hematemesis or melena or a combination of the two. Forty patients with gastric ulcers and 53 patients with duodenal ulcers were in shock. Twenty-five patients with gastric ulcers underwent surgery. Bleeding was controlled in all patients, but in the postoperative period five patients died of myocardial infarction, pulmonary embolism or septic multisystem organ failure. Of 36 patients who underwent endoscopic epinephrine sclerosis of the bleeding gastric ulcer, hemorrhage was controlled in 34. Two patients required reoperation for bleeding after surgery; both survived. Fifty patients with duodenal ulcers had surgery. Bleeding was controlled in all patients, but in the postoperative period 10 died of myocardial infarction and multisystem organ failure. Of 45 patients who underwent endoscopic sclerosis, bleeding was controlled in 40. Five patients required reoperation for bleeding after surgery; all survived. The authors conclude that endoscopic sclerosis should be the initial treatment for actively bleeding gastric and duodenal ulcers. If bleeding continues or recurs then surgery should be carried out.