Bleeding peptic ulcer: pathogenesis and endoscopic therapy.

The presence of stigmata of hemorrhage in a peptic ulcer indicate an increased risk of rebleeding and the need for endoscopic intervention. Clinical trials indicate that laser photocoagulation, multipolar and heater probe coagulation, and injection therapy are all effective in decreasing bleeding from peptic ulcer disease. The modality used for the individual patient depends on available resources and the experience of the endoscopist. Laser photocoagulation is used infrequently, not because of a lack of efficacy but because of its increased cost and impracticality, including its lack of portability. Multipolar coagulation and heater probe coagulation are commonly employed but may give way to injection therapy as first-line therapy, because it is equally effective, cost less, and is easy to implement in a variety of clinical settings.