Endoscopic control of major ulcer bleeding

Emergency surgery for bleeding ulcer still carries a significant risk. Moreover, most patients with major ulcer bleeding are poor surgical risks. Non-surgical methods that are safe and reliably control major bleeding are therefore much warranted. The most promising of various non-operative methods under investigation seems to be endoscopic application of heat delivered by laser, heater probe, or electrocoagulation. In the present study monopolar electrocoagulation with a wet probe reliably controlled major ulcer bleeding in 51 (66%) of 77 patients hemodynamically assessed as requiring emergency surgery. The endoscopic success rate in patients with gastric or duodenal ulcer was 76% and 56%, respectively. It was particularly high (87%) in 23 patients, 17 of whom fulfilled clinical criteria of having stress ulcers. The mortality rate in patients with endoscopically controlled bleeding did not differ from that in 190 patients with spontaneous cessation of ulcer bleeding (8% and 6%, respectively), none of which exsanguinated.