Efficacy of absolute ethanol injection method for stress ulcer bleeding after major surgeries

Emergency endoscopy, carried out in 342 cases of UGI overt bleeding at the Third Department of Internal Medicine, Tohoku University during the six year period from June 1979, demonstrated the necessity of endoscopic hemostasis in 171 cases (50%) with active bleeding, adhered fresh blood clot or exposed vessel with bloody gastric juice. The absolute ethanol injection method was applied to achieve hemostasis in all cases including 30 cases (18%) of postoperative stress ulcer bleeding after major surgeries. Temporary hemostasis was obtained successfully in all 30 cases and rebleeding did not develop. New bleedings in 2 cases (7%) were stopped by repeated injections of absolute ethanol. No patients died from bleeding nor underwent emergency or elective operation. Five patients (17%) died from complicated underlying diseases. Perforation developed in one case (3%). In this case new bleeding occurred on two occasions, and each time hemostasis was obtained. However, this patient showed early symptoms of perforation immediately before the third hemostasis, and was operated on after local injection of absolute ethanol. The complete hemostasis was achieved in 100% of postoperative stress ulcer cases by the ethanol method.