[Hemorrhaging peptic ulcer--Therapy? When? Which?]

The influence of frequency of surgical interventions and the time of operation on the overall mortality is still a matter of considerable controversy. A close correlation between the risk and incidence of recurrent bleeding and the primary bleeding status during emergency endoscopy let us to design a new concept of a more aggressive surgical strategy. The dominating criteria for choice of treatment based on instant endoscopical classification of bleeding type and activity. The overall mortality was 5.4%. 59 patients (53%) underwent surgery with only two hospital deaths (3.4%). Among the group with conservative treatment there were four additional deaths (7.5%), all patients being above 70 years of age. The results suggest that mortality rates in patients with bleeding gastroduodenal ulcers can be reduced by a more aggressive surgical approach.