Argon laser photocoagulation for upper gastrointestinal haemorrhage: is technique the key to success?

Reports of endoscopic laser photocoagulation have been enthusiastic. However, many technical factors influence the results and discussion of these in the literature has been very limited. We describe the problems encountered in treating 71 patients with bleeding peptic ulcers, and our solutions to them. Failures were due to problems of access and identification of bleeding points, as much as to the laser itself. Results were improved by meticulous endoscopic washing of the ulcer crater and care in setting the laser. These technical factors must be optimised before the true efficacy of this treatment can be assessed in a controlled, randomised clinical trial.