Jawad R Khersani
CABS, FICMS, Lecturer, Dep.of Surgery, University of Basrah, College of Medicine, Specialist Surgeon, Basrah General Hospital
Peptic ulcer disease is a common and life threatening emergency. The management of patients with bleeding gastroduodenal ulcer (BGDU) has evolved over the past two decades. For many years, surgery was the only treatment for BGDU. Endoscopic techniques have emerged as a successful alternative with constant improvement. Endoscopic therapy is effective in controlling 80-95% of actively bleeding ulcers and it lowers the mortality rate from BGDU by 30-40%. No study has compared surgery with endoscopic therapy; most trials of endoscopic therapy define the need for a surgical operation as a treatment failure of endoscopic haemostasis. Aim of our study is to evaluate endoscopic treatment of bleeding duodenal ulcers using injection of diluted adrenaline in comparison with surgical treatment. This is a prospective study conducted at Basrah General Hospital during the period between Jan.2004-July 2006. Twenty patients were treated by endosopic injection of diluted adrenaline (1:10000), the injection group (group I), compared with 28 patients treated by surgery, the surgically treated group (group S). The mean age was 55 and 57 years in I group and S group respectively. There were no statistically significant differences in demographic, clinical and endoscopic findings between both groups. High rate of successful initial haemostasis was achieved in group I (95%). Injection therapy failure was encountered in one patient (5%) while other two patients (10%) developed rebleeding in group I, giving overall success rate of 85% (17 patients out of 20). Two patients (7.14%) developed rebleeding in group S and one of them died. Other non-bleeding complications developed in 3 patients in group I and in 14 patients in group S. One patient (5%) died in group I from non-bleeding cause representing the total mortality. Seven patients died in group S from non-bleeding cause giving overall mortality rate of 28.5% (8 out of 28 patients). There were statistically significant differences in complication and mortality rates between the two groups. There was statistically significant difference in the amount of blood transfusion between the study groups. There was no statistically significant difference in the length of the hospital stay. Conclusion: Our results show that endoscopic injection of diluted adrenaline for patients with actively bleeding duodenal ulcer is associated with less complication and mortality rates as well as less amount of blood transfusion in comparison with surgical treatment.