We tested the hypothesis that therapeutic endoscopy using the Nd:YAG (
neodymium:
yttrium-aluminum-garnet)
laser would benefit patients with acute
peptic-ulcer bleeding. Over 43 months, 174 patients with active
bleeding (n = 32) or stigmata of recent
bleeding (n = 142) due to
peptic ulcers were randomly assigned during endoscopy to either standard treatment with
laser photocoagulation or
therapy without
photocoagulation. There were no significant differences in a number of outcomes between the group treated with
laser photocoagulation and the control group. Continued
bleeding or rebleeding was observed in 22 percent of the
laser-treated group and in 20 percent of the control group. Urgent surgery was necessary in 16 percent of the
laser-treated patients and in 17 percent of the controls.
Laser-treated patients spent a mean of 41 hours in the intensive care unit, and controls spent a mean of 32 hours. The mean
hospital stay was 12 days in the
laser-treated group and 11 days in the control group. One death occurred in each group. When patients with active
bleeding were analyzed separately, there was no significant difference in outcome, even though
laser photocoagulation stopped active
bleeding in 88 percent of cases. Among patients with visible vessels, rebleeding occurred in 5 of 14 (36 percent) who received
laser treatment and 2 of 15 (13 percent) who did not.
Laser treatment precipitated
bleeding in four patients and duodenal perforation in one. We conclude that
Nd:YAG-laser photocoagulation does not benefit patients with acute upper gastrointestinal
bleeding from
peptic ulcers.