CLINICAL STUDY ON PATIENTS WITH BLEEDING PEPTIC ULCERS WITH SPECIAL REFERENCE TO SURGICAL OR MORTAL CASES

Abstract

We performed this study in order to determine the benefits and limitations of endoscopic hemostasis for bleeding peptic ulcer and analyzed the accumulated data on patients who underwent emergent endoscopy at our hospital during a 14-year-period. Most of 12 cases with bleeding gastric ulcer requiring emergent surgery were severe (Nagao's Classifi-cation) cases with spurting lesions located on the lesser curvature to posterior wall of the angulus or body of the stomach. The pathological findings showed that the ulcer bases of these surgical cases were characteristic of causative vessels. Seven patients with gastric ulcer and 6 patients with duodenal ulcer expired within 30 days from the onset. Most of these mortal patients were severely ill cases and had other severe underlying diseases. In the mortal cases with duodenal ulcer, the endoscopic findings were characteristic, of the features of acute ulcers located in the postbulbar portion. In the retrospective analysis of bleeding duodenal bulbar ulcers, rebleeding rates of the cases with nonbleeding visible vessels or adherent clots on the ulcer base, which cases underwent endoscopic treatment by spraying only thrombin and epinephrine, were 5.6% and 15.4%, respectively. These rates were significantly lower than those of the cases with gastric ulcers. These results indicate that the exposed vessels, location of the ulcers and underlying diseases are important factors that determine the prognosis of patients with bleeding ulcer.