Endoscopic haemostasis by injection-therapy in high-risk patients

Abstract

The diagnosis of an upper gastrointestinal bleeding can be clarified quickly and reliably by emergency endoscopy. It would seem reasonable to make this efficient diagnostic approach available for therapy in order to stop the bleeding. Over a period of 2 1/2 years, we discovered an active bleeding or several recurrences during emergency endoscopy in 36 patients with a high operative risk. In these cases we attempted local haemostasis by sclerosing injections. Most patients had signs of shock at the time of admission. The average haemoglobin level was 7:42 g/100 ml, the average blood requirement was 4,4 units in the first 24 hours. 12 patients had stress lesions, 19 patients important factors militating against an operation, namely age and serious primary diseases, 5 patients had other risk factors. In 33 out of 36 patients (91.9%) haemostasis was accomplished during endoscopy. In 7 patients recurrences occurred, 3 bleeds were arrested by a repeated sclerosing. Thus definitive haemostasis was achieved in 29 patients (80.6%). We believe that it is justified to attempt endoscopic sclerotherapy in high-risk patients before undertaking an emergency operation.