Endoscopic bipolar electrocoagulation in massive upper gastrointestinal bleeding.

We have reviewed 50 cases of upper gastrointestinal bleeding treated by endoscopic bipolar electrocoagulation (BPEC) and assessed its value in the management of massive bleeding. Initial hemostasis was achieved in 94% of cases with an overall rebleeding rate of 19.1%. The rebleeding rate was high among patients requiring blood transfusions more than 2,000 ml (47.3%) and those with acute gastric mucosal lesion (AGML) (35.3%). In AGML one or two primary sites of bleeding can be effectively controlled initially, but rebleeding tends to occur from other sites. Mortality from the direct effects of bleeding was also high in massive bleeders (33.3%) and those with AGML (22.2%); the overall mortality, including deaths from ongoing underlying diseases, was 38%. Although BPEC failed to alter the fatal outcome of patients with massive acute mucosal bleeding, permanent or temporary hemostasis contributed to reducing the amount of blood transfusions, avoiding emergency operation, preventing rapid deterioration and prolonging the survival time. Endoscopic BPEC has proven to be an effective emergency hemostatic method in massive bleeding of the upper gastrointestinal tract as an alternative to surgical intervention.