Endoscopic Hemostasis of Gastrointestinal Hemorrhage by Local Application of Absolute Ethanol: A Clinical Study
SHIGERU ASAKI, TOSHIAKI NISHIMURA, AKIRA SATOH, SHUICHI OHARA, DAISUKE SHIBUYA, YUKIHIRO OGITSU and YOSHIO GOTO
The Third Department of Internal Medicine, Tohoku University School of Medicine, Sendai 980
The procedure of endoscopic hemostasis with topical injection of absolute ethanol has been developed and applied since 1975 for the control of postoperative hemorrhage associated with diathermic polypectomy. Since June 1979, upper gastrointestinal hemorrhages other than varices have also been subjected to this procedure. This method is based on the principle of dehydration and fixation of the tissue with absolute ethanol. In this procedure, the bleeding vasculatures are dehydrated and fixed with consequent vasoconstriction and necrosis of the vascular wall including its endothelial lining, thereby thrombogenesis and hemostasis are facilitated. The troubled blood vessels fixed in vivo are disintegrated and disappeared. Rebleeding from the ulcer has been extremely rare with this method since the necrotized tissue seldom defoliates but often constitutes a part of the white coating and protects the base of ulcer. Treatment by this method has been successful in all 23 cases of upper gastrointestinal hemorrhage associated with endoscopic diathermy, and none has developed rebleeding. The hemostasis has also been successful in 51 cases (72 hemorrhagic lesions) with fresh blood clots adhering to the lesion, exposed blood vessels in the lesion or an actively bleeding lesion out of 126 cases referred for emergency endoscopic examination because of upper gastrointestinal hemorrhage during the 3-year period from June 1979 to May 1982. After hemostasis, however, 3 patients received an elective operation and one patient was also operated due to perforation of the gastric wall. Rebleeding occurred in 3 cases more than a week after the hemostasis; one of these was the above-described operated case of perforation. The rebleeding occurred in stress ulcers following surgery for femoral fracture. The other two were at the terminal stage of malignancy and complicated with DIG respectively. Of the patients treated by this method, 8 died by causes other than gastrointestinal hemorrhage. All the rest of 39 cases attained cure of ulcer by the non-surgical treatment alone.
Key words G-I bleeding; endoscopy; endoscopic hemostasis; topical injection; absolute ethanol
Tohoku J. Exp. Med., 1983, 141, 373-383