Is endoscopic hemostasis sufficient in the management of bleeding peptic ulcers?

Aims Endoscopic hemostasis remains a reference treatment with the objective of stopping and reducing bleeding, avoiding surgical intervention with hemostatic aim, and reducing mortality.The objective of this study is to evaluate the effectiveness of endoscopic management of bleeding peptic ulcers.

Methods A descriptive, retrospective, analytical study over a three-year period. All patients who presented with upper GI bleeding and received endoscopic hemostasis.

Results 59 patients, the mean age was 52 years (20–79), with a sex ratio of 3.4. The main mode of revelation was the association of hematemesis with melena in 51% of cases. FOGD showed a bulbar ulcer in 67.8% of the cases and a gastric ulcer in 32.2% of the cases, with a Forrest stage IIb in 35.6% of the cases, a stage IIa in 18.6% of the cases, a stage Ib in 40.6% of the cases, and a stage Ia in two patients. The mean ulcer size was 11.5 mm (0.5–40). The mean complete Rockall score is 1.14, and the mean Glasgow-Blatchford score is 10. A combined endoscopic treatment (adrenaline injection and clip placement) was recommended in 39 patients; 11 patients benefited from clip placement alone and 9 patients from adrenaline injection alone. The evolution was favorable in 83.1% of the patients, and a second endoscopic treatment was used in 6.7% of the patients.The main predictive factors of hemorrhagic recurrence after the first endoscopic procedure were: advanced age (p=0.030), use of NSAIDs (p=0.020), initial hemoglobin level ≤ 6g/dl (p= 0.029).

Conclusions The combination of two endoscopic hemostasis techniques ensures a hemostasis with a favorable evolution in 83.1% of our structure, thus avoiding the need for surgery.

Publication History

Article published online:
14 April 2023