[Surgical hemostasis in recurrent peptic ulcer hemorrhage after endoscopic hemostasis--indications and results]

The identification of prognostic factors in patients with bleeding peptic ulcer is an important step for improving the outcome. Besides of age, concomitant diseases and bleeding activity, recurrent bleeding is the principal determinant of mortality in peptic ulcer bleeding. Obviously, there is still a considerable proportion of patients who cannot be successfully managed by endoscopic treatment alone. Therefore the identification of high-risk patients before rebleeding, an adequate early surgical intervention during a stable period after endoscopic haemostasis can prevent recurrent haemorrhage. Emergency endoscopy and, possibly, Doppler ultrasound provide prognostic relevant information allowing 'prospective' therapeutic decisions. By using this strategy in a clinical trial (291 patients) the overall mortality rate could be reduced markedly from 14% (139 patients) to 5% (152 patients). The results were mainly reproducible under clinical routine circumstances.