Abstract
To evaluate the efficacy and the limitation of emergency endoscopy for diagnosis and treatment of hemorrhagic gastric ulcers, the patients who underwent the operation due to the disease were studied. The patients were divided into three groups according to following periods : A period ; from Jan. 1970 to Dec. 1972, when the emergency endoscopy was not employed, B period ; from Jan. 1978 to Oct. 1980, when the emergency endoscopy was carried out only for the diagnosis, C period ; from Nov. 1980 to Dec. 1982, when the emergency endoscopy was carried out for the diagnosis and treatment using local injection of hypertonic saline epinephrine solution (HSE) into the lesions to arrest hemorrhage (Table 1). 1) Compared with A and B, there were not significant differences in clinical sym-ptoms between them but preoperative diagnosis was correct in more cases and operated small ulcers were fewer at B period than at A (Figure 1-7). 2) Operative rate was significantly lower at C period (13.7%) than at B (37.4%), which showed endoscopic local injection of HSE was effective in arresting hemorrhage permanently (Table 1). 3) The mean interval from admission to operation was longer at C period than at B, which showed endoscopic local injection of HSE was effective also in arresting hemorrhage temporarily (Figure 3). 4) The operated cases at C period showed following many features. They are a) past history of gastric ulcers, b) deep ulcers of U1-IV, c) ulcers at lesser curvature of the angulus and d) giant ulcers over 3 cm in diameter (Figure 4-10). Thus, here may be the limitation of the endoscopic local injection of HSE to arrest hemorrhage in those cases. Gastroenterological Endoscopy
