Review of Endoscopic Thermal Treatment of Peptic Ulcer Hemorrhage

Peptic ulcer hemorrhage is still an important cause of emergencysurgery and death. The overall mortality is around 10% from gastrointestinalbleeding, and most of the preventable deaths occur in elderly patients withcontinued or recurrent bleeding from peptic ulcers. An effective nonsurgicalmethod of hemostasis has long been recognized to be desirable. However it wasonly when the 'visible vessel' was recognized as the important risk factor forfurther bleeding that studies capable of testing new modalities adequately couldbe performed. Careful washing of the ulcer crater is essential for identification ofthese visible vessels. An effective endoscopic method was first demonstrated in1981 in patients with visible vessels treated with argon laser. Many groups havenow shown excellent efficacy of neodymium:yttrium-aluminum-garnet(NdYAG) laser in preventing further hemorrhage from ulcers with bleeding andnonbleeding visible vessels. Two controlled prospective studies havedemonstrated efficacy of the heater probe, but one well designed study did not.Similar studies with both bipolar and monopolar electrocoagulation have shownsignificant reductions in rebleeding in patients with visible vessels treated usingthe chosen modality. More recent studies have achieved excellent results bypre-injection with adrenaline and one repeat endoscopic treatment for rebleeds.A few groups have now reported equally good results with injection alone. Longterm follow-up of patients with peptic ulcer hemorrhage has confirmed prolongedhemostasis in groups treated with two thermal modalities and in controls