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Hemostatic effects of heat probe thermocoagulation for patients with peptic ulcer bleeding: an experience of 329 patients.

BACKGROUND
The mortality rate of peptic ulcer bleeding has kept around 6-10% over the past thirty years. Rebleeding is the most important adverse prognostic factor. Heat probe thermocoagulation is suspected to have good hemostatic effect, there is doubt whether the experience of performing the HPT treatment for peptic ulcer bleeding will influence the hemostatic rate. So we report our experience of a large series for heat probe thermocoagulation.


METHODS
Patients with an active bleeding source (spurting or oozing) or a nonbleeding visible vessel (NBVV) in a peptic ulcer disease were enrolled in this study. We used an Olympus GIF IT-10 or GIF 2T-10 panendoscope, an Olympus heat probe unit and a 3.2 mm probe (Olympus Co., Taipei, R.O.C.) to treat peptic ulcer bleeding. We classified the faculty into junior physician, having experience in less than 20 procedures, and senior physician, having experience in more than 20 procedures.


RESULTS
Between September 1986 and October 1993, we treated 329 patients with active bleeding or nonbleeding visible vessels at the ulcer craters. The stigmata of recent hemorrhage in these patients included spurting hemorrhage in 102 cases (31%), oozing hemorrhage in 105 cases (31.9%), nonbleeding visible vessels in 122 cases (37.1%). The bleeders were most frequently found in the stomach (181,55%), then the duodenum (133,40.4%). The energy applied to each case was 886 +/- 844 joules (mean +/- SD). The initial hemostatic rate was 95.1% (313/329). Rebleeding occurred in 74 cases (23.6%), and 52 cases received a second heat probe thermocoagulation with to result in ultimate hemostasis in 43 cases (82.7%). Junior physician obtained similar initial hemostasis rate and rebleeding rate (92.6%, 26.4%) as compared with 96.2% and 22.7% of senior physician. Totally 33 patients received emergency operation, and 5 patients died. The volume of total blood transfusion was 2830 +/- 2184 ml (mean +/- SD). The hospital stay was 7.4 +/- 4.6 days (mean +/- SD).


CONCLUSIONS
Heat probe thermocoagulation is very effective in the arrest of peptic ulcer bleeding with minimal complications and it is easy to learn in a short period of time.