[Arterial embolization can often substitute surgery in bleeding ulcer. When endoscopic hemostasis is not successful an alternative emergency treatment is needed].

Peptic ulcer disease is the most common cause of acute haemorrhage from the upper gastrointestinal tract. Despite therapeutical improvements, the mortality rate remains high. Massive bleeding may, if haemostasis is not achieved by endoscopic treatment, require surgery. Often these patients are elderly with high comorbidity and, hence, are poor surgical candidates. We have therefore used angiography and selective arterial embolisation as an alternative option in 18 patients with massive ulcer bleeding. 13 patients were treated after failed endoscopic treatment, and 5 patients were treated for recurrent bleeding after previous emergency operations for bleeding ulcers. Embolisation of the arterial branch supplying the ulcer was possible in all patients. Permanent haemostasis was achieved in all but one patient, in whom the bleeding was controlled at an emergency operation. Our opinion is that angiographic embolisation is an effective way to control massive bleeding from peptic ulcers. In this way emergency operations in poor surgical candidates can be avoided.