Injection Therapy for Nonvariceal Gastrointestinal Bleeding

Gastrointestinal hemorrhage is a common and serious problem -its average mortality of 10% has changed little over the past 40 years. In 80% ofpatients the bleeding stops spontaneously. In patients with continuous or recurrentbleeding (20%), mortality and morbidity are high, and emergency surgeryis often required, which has a higher mortality than the same operation performedelectively. Successful therapeutic endoscopic intervention in this high risk groupis necessary to improve outcome. For injection treatment of nonvariceal bleedinglesions, the author has been using the Soehendra method (1:10,000 adrenalineand polidocanol) with success in 90% of actively bleeding patients. Threecontrolled trials of endoscopic sclerosis in bleeding peptic ulcer disease showeddecreased blood transfusions, surgery and hospital stay, but did not find anysignificant difference in mortality. The ideal solution and the usefulness ofadditional therapy are questions which must be addressed via prospective controlledtrials of a large number of patients