[Endoscopic bipolar electrocoagulation in gastroduodenal hemorrhage]

During a one year period (1988-1989), 40 consecutive patients were submitted to emergency gastroduodenoscopy because of severe gastroduodenal bleeding. Indications for emergency endoscopy were red or black haematemesis with melaena or melaena with signs of haemodynamic instability. Twenty-nine of the patients fulfilled the criteria for emergency surgery because of major bleeding and alterated circulation. Twenty-five with surgery demanding gastroduodenal ulcer bleeding and one with Dieulafoy's erosion, were treated with endoscopic bipolar electrocoagulation. Primary haemostasis was achieved in 20 patients (80 per cent). Definitive haemostasis was obtained in 11 patients (44 per cent) with major ulcer bleeding. Nine patients bled again after electrocoagulation, and seven of these underwent surgery. The mortality was 20 per cent (five patients). In eight patients with minor active bleeding or visible vessels, electrocoagulation resulted in 100 per cent definitive haemostasis. No complications attributable to the electrocoagulation were observed. Endoscopic haemostatic treatment with e.g. bipolar electrocoagulation should be the first treatment in patients with gastroduodenal bleeding as emergency operation can be avoided in approximately 50 per cent of the cases.