[Operation or conservative therapy? New aspects based on further differentiation of emergency endoscopy findings in hemorrhage of gastrointestinal ulcers].

In a retrospective study the clinical courses of 121 patients with bleeding peptic ulcers were reviewed. The possibility for endoscopic prediction of recurrent bleeding was evaluated. The criteria specific to recurrent hemorrhage, which we found in bleeding ulcers during emergency endoscopy, led us to a modification of the Forrest-classification. All spurting arterial bleedings, which could be stopped by endoscopic means and all lesions with a big visible vessel in the ulcer crater had a high risk of recurrent bleeding. Therefore early surgical treatment should be performed soon after stabilisation of all vital functions and compensation of the blood loss. The emergency endoscopy enables not only an accurate diagnosis, but also a prediction and prognostic judgement of recurrent bleeding. This will give the surgeon valuable informations on deciding an operative or conservative treatment.