P R E S S   R E L E A S E

Bleeding peptic ulcer is a common medical emergency which carries a mortality of around 10 per cent.  Hong Kong has one of the highest incidence rate in the world (169 per 100,000).  Surgery used to be the only effective means in stopping bleeding. A quarter to a half of patients required surgery which was often associated with morbidity and occasional mortality.  

The Endoscopy Centre at the Prince of Wales Hospital, the Chinese University of Hong Kong, has been at the forefront in clinical research on endoscopic therapy to bleeding peptic ulcer. The Centre has for the past 10 years treated over 10,000 patients with bleeding peptic ulcers and found that an overwhelming majority of actively bleeding peptic ulcers is amenable with endoscopic treatment.  In a randomized study published in 1988 in the British Medical Journal, the Centre demonstrated that injection with adrenaline via the endoscope was an effective method to stop ulcer bleeding.  Endoscopic adrenaline injection was shown to reduce the need for blood transfusion and surgery.  In 1997, the British Medical Journal again reported that the Centre combined adrenaline injection and the thermal method of heater probe in treating bleeding peptic ulcers. The combined method further improved the efficacy of endoscopic therapy. Now only about 3 to 4 per cent of patients require surgery, one of the lowest in the world. The overall mortality has been consistently around 4 to 5 per cent compared to the average of 10 per cent reported by centres in the West.

Endoscopic therapy is especially applicable to elderly patients.  In an aging population, patients with the condition are often elderly patients with co-morbid illnesses. The proportion of elderly patients with upper gastrointestinal bleeding dramatically increased over recent decades (33 per cent of patients were older than 60 in the 1940's compared to that of 68 per cent in the 1990's).

The applicability of endoscopic therapy in bleeding peptic ulcer is greatly enhanced with the discovery of Helicobacter pylori and powerful ulcer healing drugs such as proton pump inhibitors. Endoscopic therapy stops bleeding and these drugs heal peptic ulcers and more importantly prevent their recurrences. 

The Chinese University of Hong Kong recently concluded a 3-year long clinical trial at the Prince of Wales Hospital.  During this period, over 3,500 patients were admitted for peptic ulcer bleeding and a third of them received the combined adrenaline injection and heater probe treatment. Only about 100 patients (8.7 per cent) developed recurrent bleeding. Traditionally these patients would undergo surgery. Comparing endoscopic re-treatment to surgery, researchers found that endoscopic re-treatment could be successful in about three-quarter of patients. In selected patients, endoscopic re-treatment was associated with less morbidity and avoiding surgery was clearly beneficial. Findings of the study have gained international recognition and are being published in the New England Journal of Medicine, the top international clinical journal.