Endoscopic hemostasis of gastrointestinal hemorrhage by local application of absolute ethanol: A clinical study.

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Abstract
The procedure of endoscopic hemostasis with topical injection of absolute ethanol has been applied since 1975 for the control of postoperative hemorrhage associated with diathermic polypectomy. Since 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 affected 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 was successful in all 23 cases of upper gastrointestinal hemorrhage associated with endoscopic diathermy, and none developed rebleeding. The hemostasis was also 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-yr period from June 1979-May 1982. After hemostasis, however, 3 patients received an elective operation and 1 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 2 were at the terminal stage of malignancy and complicated with DIC [disseminated intravascular coagulation], respectively. Of the patients treated by this method, 8 died by causes other than gastrointestinal hemorrhage. The rest of the 39 cases were cured of ulcers by the nonsurgical treatment only.