Endoscopic electrocoagulation of major bleeding from peptic ulcer

Endoscopic electrocoagulation with a liquid monopolar probe was exclusively attempted in 77 patients with major bleeding from peptic ulcer assessed as requiring emergency surgery. Endoscopy failed to control bleeding in 14 patients (18%), who proceeded directly to surgery. Initial endoscopic hemostasis was obtained in 63 patients, but hemorrhage recurred in 18 (29%). Rebleeding required surgery in 11 patients and another patient died prior to surgery. Permanent endoscopic control was achieved in 51 patients (66%). Without difference in transfusion requirement, endoscopy was most likely to succeed in patients with superficial acute ulcer, onset of bleeding in hospital, gastric ulcer, no earlier history of dyspepsia and in patients with previous ulcer surgery. Endoscopy was less likely to succeed in patients with chronic duodenal ulcer or earlier dyspepsia, though it controlled major bleeding in more than half of such patients. Profuse bleeding, and in particular poor access in a narrowed duodenal bulb, were important determinants of endoscopic failure. Of the patients with permanent endoscopic hemostasis, 8% subsequently underwent elective ulcer surgery. Endoscopic electrocoagulation is safe and has potential to control major bleeding, obviating emergency surgery, in two-thirds of the cases. As the less invasive method, endoscopy should be attempted before surgery, particularly in patients regarded as poor surgical risks or with no history of dyspepsia.