Peptic upper gastrointestinal bleeding: diagnosis and treatment. A monocentric experience on a 5 years period

Abstract

Aim: We evaluated all the cases of upper gastrointestinal hemorrhages admitted in the Department of Endoscopy of our Clinic during a 5 years period.

Material and method: 810 patients were included in our study, 64.3% males and 36.7% females, mean age 58.7 +/- 15.2 years (17-96 years). The main cause of the upper digestive hemorrhage was peptic ulcer (82.6%), equally divided in gastric and duodenal. All the ulcers were assessed according to the Forrest classification.

Results: Endoscopic haemostasis was performed in 40% of all cases, only epinephrine injection (1/10,000) in 44.4% of cases; combined therapy (injection + clip or thermocoagulation) in 40.3% of the cases and clip or thermocoagulation alone in 15.3% of the cases. A marked reduction of haemostasis using epinephrine injection alone (as monotherapy) was observed during the period of study. Postendoscopic treatment rebleeding occurred in 19.8% of cases; 3.6% of the patients have had a fatal outcome and surgical treatment was needed in 2.7% of cases.

Conclusion: In an experienced Department of Endoscopy, the majority of upper gastrointestinal hemorrhages can be endoscopically treated with good results. In the last years, endoscopical haemostatic bitherapy (adrenaline injection+clipping or bipolar coagulation) replaced injection of adrenaline like monotherapy for ulcer hemostasis.