Abstract
Endoscopic Doppler ultrasound enables the reliable identification of vessels in the
base of gastroduodenal ulcers. In a prospective study including 114 patients with
acute ulcer bleeding, pulsed Doppler ultrasound was able to demonstrate superficial
blood vessels in the ulcer base in 62 % of 106 cases where complete Doppler assessment
was possible (93 %). Agreement between the endoscopic pattern of visible vessels and
the Doppler ultrasound findings was attained in only 52 % of the cases. Doppler positive
ulcers (n = 66) were treated with injection therapy (if necessary, repeated), irrespective
of their Forrest classification. Using such an approach, the rebleeding rate in this
group decreased to less than 8 % and none of the patients died of causes related to
the hemorrhage. All Doppler negative ulcers (n = 40) healed without complications
or the need for endoscopic treatment; among these were 11 cases with Forrest IIa and
b. We conclude that endoscopic Doppler appears to be a valuable diagnostic procedure
in the assessment of bleeding ulcers, thus modifying the Forrest classification. Our
concept is that Doppler positive ulcers require local endoscopic treatment, whereas
Doppler negative ulcers can be treated conservatively.
