Efficacy of repeated therapeutic endoscopy in patients with bleeding ulcer

Although therapeutic endoscopy is regarded as the procedure of choice for bleeding ulcers, the disease mortality is barely altered. The aim of the present study was to evaluate the efficacy of repeated therapeutic endoscopy in patients with bleeding ulcer.

From January 1990 to April 1995, 727 patients with bleeding ulcers were admitted to hospital under the care of one gastroenterologist who endoscoped every patient within 18 hours of admission. Epinephrine (1:10,000) was injected into the lesions of patients found to have active bleeding, a non-bleeding visible vessel, or adherent red clot. After the initial diagnostic-therapeutic procedure, all patients admitted from 1990-92 (group A) were treated conservatively, and referred for operation if re-bleeding was uncontrolled. Patients admitted from 1993 to April 1995 (group B) were treated aggressively with re-endoscopy one day later, and repeat hemostasis if re-bleeding was evident. During hospitalization, diagnostic/therapeutic endoscopy was then repeated if re-bleeding was diagnosed by either a fall in hematocrit of > 3%, or on clinical criteria. Patients were transfused if the hematocrit fell to < 30%.

Repeated hemostasis was needed in 30 group B patients; one patient requiring 7 therapeutic endoscopies. The outcome of patients in group B was better than group A, with fewer emergency operations (3 vs 10) (p < 0.05) and deaths (0 vs 4) (p < 0.05), while no difference was seen in transfusion requirements (4.1 vs 3.9 units) (p > 0.1), or in length of hospital stay (6.8 vs 7.1 days) (p > 0.1).

Repeated diagnostic/therapeutic endoscopy benefits patients with bleeding ulcers.