Endoscopic intervention: a useful alternative to operation in the treatment of upper gastrointestinal hemorrhage.

Hemorrhage of the upper gastrointestinal tract (UGI) remains a serious clinical problem. Age of the patient, the presence of shock, transfusion requirements and concurrent serious illnesses are predictors of outcome. Operative intervention is promulgated if a visible vessel in an ulcer crater is identified because most will rebleed. From 1986 to 1988, 40 patients with 46 actively bleeding upper gastrointestinal lesions were treated with endoscopic intervention (EI). The Nd:YAG (neodymium yttrium aluminum garnet) laser using the noncontact method was used exclusively. All patients had orthostatic hypotension on admission and had serious intercurrent illnesses. Admission hematocrit ranged from 13 per cent to 36 per cent (median, 24%) and patients had been transfused an average of 4 units of blood before EI. Gastric and duodenal ulcers were the most common bleeding sites. All gastric and duodenal ulcers had visible vessels and 19 were actively bleeding. Endoscopic intervention was initially successful in 35 of 40 (87.5%) patients. The five patients who did not respond required urgent operation with a mortality rate of 40 per cent. Four patients rebled after EI but responded to repeat EI. The mortality rate in the EI group was 8.6 per cent. These results suggest that EI is a useful alternative in UGI bleeding for a select group of those patients at high risk for operative intervention.