The role of endoscopy in the hemorrhagic complications of gastroduodenal ulcer.

The hemorrhage is a fairly frequent event in the evolution of the gastroduodenal peptic ulcer syndrome. The mortality rate has remained approximately unchanged, in spite of the progress in instrumental diagnosis and medical therapy, in the last decade. The authors examine 163 cases of digestive hemorrhage from gastroduodenal ulcers, observed in the last five years (1984-1988), with particular reference to the medical or surgical treatment undertaken, and to the mortality rate. Gastroduodenal ulcers, in 340 cases of upper digestive hemorrhage, represented nearly half the lesions, registered in the same period. Duodenal ulcers (D.U.), were found in 124 patients (34.4%) and gastric ulcers (G.U.) in 39 patients (11.47%), 113 (91.1%) patients with D.U., and 33 (84.6%) patients with G.U. were treated by medical therapy. The mortality rate in this group was 6.16%. II patients (8.9%) with D.U. and 6 patients (15.3%) with G.U. were operated on. The surgical mortality rate was high at 35.2%. Total mortality rate was 9.2%. The endoscopic exam was useful for diagnostic bleeding investigation and contributed to therapeutic decisions. Active bleeding lesions were found in 38.4% of patients with G.U. and in 32.3% with D.U. In 61.6% of patients with G.U. and in 67.7% with D.U., the lesions had already stopped bleeding; but in both lesions nearly 40% of cases, presented signs of a recent hemorrhage. The prognosis and natural history of the hemorrhage, was not changed by an immediate exam. The clinical reports and the data furnished, especially from continuous bleeding and rebleeding lesions, could be useful in identifying a sub-group of patients who could obtain better results by surgical treatment within a suitable time. The endoscopy, besides selecting and contributing to a better therapeutic strategy, through haemostasis technic, could reduce mortality rate from gastroduodenal ulcer lesions.