[The concept of endoscopy-related therapy in gastroduodenal ulcer hemorrhage]

In a prospective study a new therapeutic concept was tested on 76 patients with bleeding gastroduodenal ulcers. During emergency endoscopic an exact inspection of the ulcercrater helped to determine the possibility of recurrent bleeding of the ulcer. This possibility was expressed in a modified Forrest-classification. Endoscopic hemostasis has been performed in all cases of active bleeding. Ulcers with a big visible vessel stump should be operated early elective after an intervall of intensive care, because definitive endoscopic hemostasis seemed not to be sufficient with this bleeding type. The new concept decreased the operation frequency of bleeding gastroduodenal ulcers from 51% in 1981/82 to 34% in 1983. Mortality of bleeding duodenal ulcers decreased from 18% to 8,6%, in bleeding stomach ulcers from 24% to 18%. Endoscopic hemostasis with injection therapy has proved to be most successfull in the F1b bleeding type.