Upper-gastrointestinal tract hemorrhage is a terrifying experience for the patient and an urgent challenge to the physician. Despite the best treatment and the widespread use of whole blood, patients with upper-gastrointestinal tract hemorrhage continue to have mortality of more than 10%.1-3 The outlook is even more distressing in elderly patients and in those with associated diseases.
Why are patients still bleeding to death? Has the ready availability of blood dulled our sense of urgency? Is there delay in initiating therapy, or is current therapy ineffective? Are we so absorbed in how well the patient responds to the initial therapy that the operative mode of treatment has not been selected until the patient is in more serious condition than when the treatment was started? Have we felt too capable of our own surgical skills and failed to vary the technical approach in these patients to meet the risks encountered?