1985 Volume 22 Issue 1 Pages 26-31
There were 57 cases of hemorrhagic gastro-duodenal ulcers, on whom endoscopic local injections of absolute ethanol was performed because of active bleeding or fresh blood clots in emergent endoscopic examinations for 3 and a half years from June 1979 to January 1983. Of them, 25 cases over 60 years old were evaluated. There were 20 cases of gastric ulcer (80%) and 5 cases of duodenal ulcer (20%), including 2 cases of post bulbar ulcer. Of gastric ulcers, 10 were in the C region, 8 in the M region and 2 in the A region. They located comparatively in the upper portion of the stomach, and 40% of them were multiple ulcers. Bleeding conditions were as follows: Projective hemorrhage 4, venous hemorrhage 4 and fresh blood clots 17. Exposed vessels were observed in 13 cases. Fifteen cases (60%) developed shock because of massive bleeding. As basic diseases, 11 were malignant neoplasma and its postooerative cases, 2 postoperative cholelithiasis, 3 severe diabetes mellitus, 2 congestive heart failure and 5 miscellaneousness. Many were considered to have high risk for emergent operation for hemorhage. Endoscopic hemostasis by local injection of absolute ethanol was successful in all 25 cases. Except for 3 cases died of basic diseases and one case of the embolism of superior mesenteric artery for which elective operation was performed after hemostasis, 21 cases colud be medically cured.
Massive bleeding or re-bleeding often occurs and conservative treatment sometimes fails in elderly gastric ulcer patients. Additionally, the prognosis of surgical treatment was not so good because of severe complications. Endoscopic hemostasis by local injection of absolute ethanol has reliable efficacy and has succeeded in hemostasis in these cases, for whom the emergent operation is absolutely indicated, and has made it possible to cure by elcctive operation or conservative treatment. It is quite significant that this method is effective curable conservatively for elderly gastroduodenal ulcer patients, who have required nothing but surgical operations and had high mortality.
