From Endoscopic Hemostasis to Bleeding Peptic Ulcers: Strategies to Prevent and Treat Recurrent Bleeding

Abstract

Endoscopy is advocated in the treatment of peptic ulcers with active bleeding, nonbleeding visible vessels or adherent clots. From pooled analysis, the initial rates of hemostasis exceed 94% in most large series. 1 There remains a subgroup of patients with continued or recurrent bleeding despite of endoscopic treatment, which is associated with much increased mortality. After initial endoscopic control, there are several strategies to prevent recurrent bleeding. These include (1) the use of an intravenous infusion of a high-dose proton pump inhibitors (PPI), (2) routine second look endoscopy the next morning to repeat endoscopic therapy if there remains a vessel, and (3) early elective surgery or angiographic embolization to the bleeding vessel in ulcers judged to be at high risk of recurrent bleeding. Because there is an increasing cognizance that elderly patients with peptic ulcer bleeding may die from nonbleeding causes, a balance between prevention of rebleeding and prevention of cardiovascular and cerebrovascular complication is emphasized in recent studies.