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How efficient is endoscopic injection sclerotherapy in peptic ulcer hemorrhage
1Maribor Teaching Hospital, Department of Gastroenterology and Endoscopy, Slovenia.
Insights
Endoscopic injection sclerotherapy for bleeding peptic ulcers was successful in most patients. A small percentage required surgery due to persistent hemorrhage, with some postoperative mortality observed.
Area of Science:
- Gastroenterology
- Endoscopic interventions
- Surgical management of gastrointestinal bleeding
Background:
- Peptic ulcer hemorrhage is a significant global health issue, contributing to substantial morbidity and mortality.
- Effective management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To determine the rate of surgical intervention in patients with bleeding peptic ulcers when endoscopic hemostasis fails.
- To evaluate the efficacy and safety of injection sclerotherapy for peptic ulcer hemorrhage.
Main Methods:
- Retrospective analysis of 233 patients with bleeding peptic ulcers (gastric and duodenal) treated between January 1994 and November 1995.
- Urgent endoscopic examination and hemostatic interventions using injection therapy (adrenaline and polidocanol).
- Classification of ulcers based on Forrest's bleeding activity criteria.
Main Results:
- Injection sclerotherapy was performed on all patients.
- Endoscopic hemostasis failed in 10 patients (4.2%), necessitating surgical treatment (5 gastric, 5 duodenal ulcers).
- Five patients died postoperatively due to complications.
Conclusions:
- Endoscopic hemostasis, particularly injection sclerotherapy, is a cost-effective, safe, and widely applicable treatment for peptic ulcer hemorrhage.
- Early elective surgery is recommended for high-risk patients, including the elderly with comorbidities, after initial endoscopic hemostasis.
- Endoscopic hemostasis has significantly impacted the surgical management of peptic ulcer bleeding.
Background/Aims:
Peptic ulcer hemorrhage is a common, worldwide problem and a major cause of morbidity and mortality. The aim of this study was to establish the percentage of patients with bleeding peptic ulcers who were treated surgically because endoscopy failed to stop the hemorrhage.
Methodology:
This retrospective analysis includes patients from our institution who underwent urgent endoscopic examination of the upper digestive tract and hemostatic interventions with injection therapy (sol. 1:10000 adrenaline and 1% polidocanol) between January, 1994 and November, 1995.
Results:
Two hundred thirty-three patients with bleeding peptic ulcers were examined: 111 with bleeding gastric ulcers (66 males, 45 females; average age 60.21 years, SD +/- 13.94; span 28-94 years) and 122 with bleeding duodenal ulcers (95 males, 27 females; average age 55.24 years, SD +/- 17.35; span 16-88 years). In all patients, injection sclerotherapy was performed. The ulcers were classified according to Forrest's classification of bleeding activity. In 10 patients (4.2%) with acute hemorrhage (6 males; average age 63.2 years, SD +/- 5.6; span 53-70 years: 4 females, average age 61.0 years, SD +/- 11.82; span 51-81 years), endoscopic hemostasis did not prove successful and they were treated operatively. In 5 cases, the cause of hemorrhage was a gastric ulcer and in 5 others, duodenal ulcer. During the postoperative period, 5 patients died of complications.
Conclusions:
Endoscopic hemostasis has been a major therapeutic advancement in the management of peptic ulcer hemorrhage and has influenced surgical management. Injection sclerotherapy is a low cost, effective and safe procedure which is easy to implement in a variety of clinical settings. Early elective operation after initial endoscopic hemostasis is the wisest choice for elderly patients with co-existing disease and selected patients at high risk for recurrent bleeding.