[Combined injection/endoscopic sclerotherapy of upper gastrointestinal peptic ulcer hemorrhage].

In the last 8 years period 369 patients with acute upper gastrointestinal bleeding were admitted to the Department of Internal Medicine, District Hospital Siófok. All patients were treated by combined injection sclerotherapy during the urgent endoscopy. The sclerotizing solution contained at the first step ethamsylate, calcium gluconate, epinephrin, hypertonic saline solution, and the second step 1% aethoxysklerol. At he time of urgent endoscopy 77% of the patients had acute bleeding (Forrest I.a., I.b.) and 23% of them showed stigmata of fresh bleeding (Forrest II.a., II.b.). Primary endoscopic hemostasis was achieved in all patients. In 7.9% of patients (n = 29) developed recurrent bleeding during the observation period, who were resclerotized. Twenty of them (5.4%) were treated by elective surgery. No hemorrhagic or sclerotizing therapy associated mortality occurred. Five out of 20 operated patients (1.4% of all sclerotized cases) had died due to the serious complications of their chronic liver disease. Patients with succesful initial endoscopic hemostasis were treated conservatively (proton pump inhibitors, H-2 blockers, antacids, sucralfate, lactulose) and underwent control endoscopy after 24 hours. Using this sclerotizing method in the treatment of acute upper gastrointestinal bleedings the number of acute surgery and mortality decreased significantly. It is supposed, that the locally administered ethamsylate, calcium gluconate, epinephrin, hypertonic saline solution and aethoxysklerol containing sklerotizing solution might play a favorable role in the successful control of acute bleeding ulcers.