The effect of introducing endoscopic therapy on surgery and mortality rates for peptic ulcer hemorrhage. A single center analysis of 1,125 cases.
The introduction of early endoscopic diagnosis has not been associated with a reduction in either surgical intervention or overall mortality for peptic ulcer hemorrhage. Recent studies have suggested that endoscopic therapy can reduce rebleeding rates from peptic ulceration. We report a 2-year experience of the influence of endoscopic heater probe (HP) (Olympus CD 10Z) therapy on the outcome of patients admitted with peptic ulcer hemorrhage. Eight hundred and sixty-two patients admitted with peptic ulcer hemorrhage over a 5-year period (1978/9 and 1983/5) before endoscopic therapy (PRE-HP), and 263 patients admitted with peptic ulcer hemorrhage after introduction of endoscopic therapy (POST-HP: 1986-1988) were assessed. All 1,125 patients were managed by a joint physician/surgeon team. The introduction of HP therapy was associated with a reduction in surgical intervention and overall mortality rates for gastric ulceration from 16% and 8.9% PRE-HP to 7% and 2.6% POST-HP respectively (p less than 0.05). A similar but non-significant trend was noted for duodenal ulceration. The beneficial effects of HP therapy appear to be due to a reduction in the need for surgical hemostasis in patients with an ulcer base visible vessel. Our results suggest that a more widespread use of endoscopic therapy may result in an improved outcome from peptic ulcer hemorrhage.
Fullarton
G M
GM
University Department of Surgery, Western Infirmary, Glasgow.
Birnie
G G
GG
MacDonald
A
A
Murray
W R
WR
D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies