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 < 0.05). A similar but not-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 a more widespread use of endoscopic therapy may result in an improved outcome from peptic ulcer hemorrhage.