Gastroduodenal ulcer hemorrhage: endoscopic injection therapy using a fibrin sealant

In a retrospective analysis of bleeding upper gastrointestinal ulcers we examined the clinical outcome of the patients observed during the period 1989-1991. Out of 452 patients with benign gastric or duodenal ulcers, 85 patients exhibited stigmata of fresh bleeding (5.9% Forrest Ia, 24.7% Ib, 45.9% IIa and 23.5 IIb) and were treated endoscopically by the injection of fibrin sealant with or without additional hypertonic saline plus epinephrine. The endoscopic therapy was repeated until Forrest grade III was reached. Initial endoscopic hemostasis was achieved in all, permanent hemostasis in 85.9%, of the patients treated. The overall bleeding-associated mortality was 7.0%, in 9.4% continued bleeding required surgery. No therapy-associated complications were seen. Interestingly, the fibrin clot appeared to induce rapid healing of ulcers. It may be concluded that fibrin sealing is a complication-free, highly effective endoscopic therapy.