Endoscopic ethanol sclerotherapy in non‐variceal gastrointestinal bleeding

Abstract

Upper gastrointestinal bleeding still causes significant morbidity and mortality in spite of an aggressive medical and surgical approach. Endoscopic methods of treatment promise early and effective non‐surgical control of bleeding. Endoscopic injection of ethanol has been used to control gastrointestinal bleeding in a prospective study of 28 high risk patients. Twenty‐two had chronic ulcers (12 duodenal, 10 gastric) and six had angiodysplastic lesions (three gastric, three caecal). The 22 patients with chronic peptic ulcers were either elderly (median age 69 years) or had serious associated medical disorders (73%); 64% presented with shock. Primary haemostasis was achieved in all, but two re‐bled from their ulcer. Surgery was required in one patient who re‐bled 48 h after treatment and in one patient with an ulcer which perforated 45 days after injection; three patients with chronic ulcers refractory to medical therapy also underwent surgery. One patient developed a closed perforation of an antral ulcer after treatment which settled with conservative management; two patients died from causes unrelated to their ulcer. It is concluded that ethanol sclerosis is a safe, effective method for controlling bleeding from chronic peptic ulcers and angiomatous malformations.