Percutaneous endoscopic treatment of bleeding gastric ulcers

Bleeding gastric ulcers have a propensity to occur in the critically ill and elderly. Various treatments include endoscopic or surgical intervention. The endoscopic route may have as high as a 25 percent rebleeding rate and a 50 to 90 percent rebleeding rate if there is a visible vessel. Surgical intervention has a mortality rate of as high as 25 percent. Described is a procedure which combines endoscopic and surgical techniques for the treatment of bleeding gastric ulcers--the percutaneous endoscopic method. To evaluate the technique and efficacy of this procedure, a bleeding ulcer was created in a porcine stomach with multiple applications of standard biopsy forceps. After brisk hemorrhage developed, the percutaneous endoscopic method was employed and cessation of bleeding obtained. The entire procedure was completed within 20 minutes. There were no immediate complications. Overall costs were much less than those for routine general surgery and about the same as for placement of percutaneous gastrostomy tube.