THE INDICATIONS OF ENDOSCOPIC HEMOSTASIS FOR DIEULAFOY'S ULCER : EVALUATION OF HYPERTONIC SALINE-EPINEPHRINE SOLUTION INJECTION METHOD

Abstract

The indication of endoscopic hemostasis by local injection of Hypertonic saline-Epinephrine solution (HSE method) for Dieulafoy's ulcer was assessed, based on 10 cases which had been experienced at Yoyogi Hospital between 1981 and 1987. HSE method was performed in 9 of 10 cases with Dieulafoy's ulcer. Sex ratio was 8:2 (M:F). Age distribution was 34-82 years with the mean of 57 years. Surgery was not indicated in 6 cases due to severe complications. There were 4 cases with the past history of gastric ulcer. Five cases were located in the gastric body, 3 cases were located in the incisura region, and 2 cases were located in the gastric antrum. Endoscopically, fresh blood was present in 6 cases. Pulsating bleeding was in 1 case, oozing in 2 cases, blood coagula forming in 1 case, and exposed vessel only in 5 cases. Local injection of HSE was tried 1 to 4 times, with the mean of 1.8 times, and permanent hemostassis was achieved in 8 of 9 cases (88.9%). In the same period HSE method had been performed in 191 cases with bleeding peptic ulcer excluding Dieulafoy's ulcer, and permanent hemostasis was achieved in 93.2% (178/191) with the mean injection of 1.8 times. No difference in the hemostatic effect was found between Dieulafoy's ulcer and other peptic ulcers. There were severe complication in 14.7% (28/191) in which surgery was not indicated. Permanent hemostasis was obtained in 82.1% (23/28) of these cases. HSE method was unsuccessful in the cases with penetrat-ing or nearly penetrating ulcer, multiple ulcers in the gastric body, those complicated with hepatic and renal failure, and those immediately after renal dialysis. It may be ascribed to the absence of penetration in Dieulafoy's ulcer that favorable hemostatic effect was obtained despite severe complications and thick blood vessels exposed. Endoscopic hemostasis by HSE method is considered to be the first choice of treatment for Dieulafoy's ulcer as well as other bleeding peptic ulcers.