Endoscopic treatment of bleeding peptic ulcer.

Several endoscopic modalities have the potential of controlling major, life-threatening ulcer bleeding. Although none of the modalities has emerged to be more efficacious than the other, current evidence favours thermal methods and injection therapy. When successful, the endoscopic methods are equally safe (associated with a risk of perforation less than 2%), although a rebleeding rate of 10-30% is of concern. Endoscopic therapy is in general operator-dependent, and the experience of a team is probably more important than the choice of equipment. Selection of patients for endoscopic therapy should be based on the identification of high-risk patients who tolerate rebleeding or surgery poorly, and high-risk lesions likely to rebleed. Endoscopic therapy for ulcer bleeding is simply a new way of applying surgery. Realizing this, it is difficult to understand why therapeutic endoscopy for bleeding ulcer has not yet been widely adopted by surgeons.