Endoscopic electrocoagulation of major bleeding from peptic ulcer

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endoscopic Interventions

Background:

• Peptic ulcer bleeding is a significant cause of emergency surgery.
• Effective endoscopic hemostasis is crucial for managing major gastrointestinal hemorrhage.
• Previous surgical interventions may influence outcomes of endoscopic treatments.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic electrocoagulation for major peptic ulcer bleeding.
• To identify patient factors associated with successful endoscopic hemostasis.
• To compare endoscopic treatment with emergency surgery for peptic ulcer hemorrhage.

Main Methods:

• Endoscopic electrocoagulation using a liquid monopolar probe was performed on 77 patients with major peptic ulcer bleeding.
• Patients were assessed for initial hemostasis, recurrence of bleeding, and need for surgery.
• Factors influencing endoscopic success, including ulcer type, bleeding characteristics, and patient history, were analyzed.

Main Results:

• Initial hemostasis was achieved in 63 patients (82%), with permanent control in 51 (66%).
• Bleeding recurred in 18 patients (29%), necessitating surgery in 11.
• Endoscopic success was higher in superficial acute ulcers, gastric ulcers, and patients with prior ulcer surgery; profuse bleeding and poor access were determinants of failure.

Conclusions:

• Endoscopic electrocoagulation is a safe and effective method for controlling major peptic ulcer bleeding in approximately two-thirds of cases.
• It obviates the need for emergency surgery in a significant proportion of patients.
• Endoscopy should be considered the primary treatment modality before surgery, particularly in patients with poor surgical risk or no history of dyspepsia.