[Importance of endoscopic hemostasis in peptic ulcer hemorrhage in a teaching hospital].
BACKGROUND
The results of endoscopic treatment for bleeding peptic ulcers in a teaching hospital are little reported. Most studies are published by a limited number of specialized authors with a reported success rate of 76-83%. The aim of this study is to evaluate the success rate in a teaching hospital.


METHODS
We retrospectively studied 150 patients hospitalized in our service between 1994 and 1995. They comprised 59 females (median age 80.5 [24-93] years) and 91 males (median age 61.5 [26-98]). 49% were aged 70 or over. 39 patients (29%) had a past history of peptic ulcer disease, the others being admitted for an initial episode of bleeding ulcer. Biopsies for urease test were obtained in 84 patients. In this group the prevalence of Helicobacter pylori infection was respectively 88% and 58% in subjects with a history of ulcer disease and in those with an initial episode of bleeding ulcer. 46% and 54% respectively had taken nonsteroidal anti-inflammatory drugs during the previous weeks. Neither of these two risk factors was present in 9 patients without a previous history of ulcer disease; they were present in none of those with a history.


RESULTS
All patients underwent emergency esogastroduodenoscopy; 48 underwent endoscopic hemostasis. 12 gastroenterologists were involved in these procedures. The definitive success rate is 81%. The success rate for a first hemostasis for a posterior bulbar ulcer is 41% vs 88% for the other localizations, a difference which is statistically significant (p = 0.002). Endoscopic hemostasis showed a higher failure rate where the bleeding stigmata was a spurting vessel (44% vs 18%) but this was not significant (p = 0.18).


CONCLUSIONS
Endoscopic treatment for bleeding peptic ulcer is effective in a teaching hospital. The technique shows a higher failure rate for posterior bulbar ulcers. In view of the risk of recurrence, patients should be kept in hospital after a first procedure.
Chautems
R
R
Clinique et Policlinique de Chirurgie Digestive, Hôpitaux Universitaires, Geneve.
Majno
P
P
Frossard
J L
JL
Hadengue
A
A
Morel
P
P
Huber
O
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016145:Endoscopy, Digestive System; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006489:Hemostatic Techniques; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000628:therapy*; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D012597:Sclerosing Solutions; D014662:Vasoconstrictor Agents; D000077423:Polidocanol; D011092:Polyethylene Glycols; D004837:Epinephrine
Intérêt de l'hémostase endoscopique des hémorragies ulcéreuses dans un centre d'enseignement.