Injection Therapy for Nonvariceal Gastrointestinal Bleeding

Abstract

Gastrointestinal hemorrhage is a common and serious problem - its average mortality of 10% has changed little over the past 40 years. In 80% of patients the bleeding stops spontaneously. In patients with continuous or recurrent bleeding (20%), mortality and morbidity are high, and emergency surgery is often required, which has a higher mortality than the same operation performed electively. Successful therapeutic endoscopic intervention in this high risk group is necessary to improve outcome. For injection treatment of nonvariceal bleeding lesions, the author has been using the Soehendra method (1:10,000 adrenaline and polidocanol) with success in 90% of actively bleeding patients. Three controlled trials of endoscopic sclerosis in bleeding peptic ulcer disease showed decreased blood transfusions, surgery and hospital stay, but did not find any significant difference in mortality. The ideal solution and the usefulness of additional therapy are questions which must be addressed via prospective controlled trials of a large number of patients.