Endoscopic neodymium:YAG laser coagulation in gastrointestinal hemorrhage

The aim of a resolute, endoscopic treatment in acute gastrointestinal hemorrhage by a neodymium:YAG laser is to prevent massive loss of blood and to avoid transformation of the hemorrhagic shock event into an irreversible state. Parallel to endoscopic procedure treatment of coagulopathies is necessary. 1,029 (94%) out of 1,092 acute bleeding episodes of 852 unselected patients were treated successfully. In bleeding esophageal varices, reduction of mortality from 70% to 36.2% has been achieved by sclerotherapy following laser coagulation of the acute bleeding. Compared with the results of surgery the mortality rate of bleeding acute ulcers has been reduced from 58% to 23.4%, and of bleeding chronic ulcers from 25% for resection and 15% for vagotomy to 0%. For optimal treatment of the patients close cooperation with surgeons is also desirable.