BACKGROUND & AIMS
For 4 decades, stigmata of recent hemorrhages in patients with non-variceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata is rarely monitored, but can be used to determine risk for rebleeding. We performed a randomized controlled trial to determine whether Doppler endoscopic probe monitoring of blood flow improves risk stratification and outcomes in patients with severe non-variceal upper gastrointestinal hemorrhage.
METHODS
In a single-blind study performed at 2 referral centers, we assigned 148 patients with severe non-variceal upper gastrointestinal bleeding (125 with ulcers, 19 with Dieulafoy’s lesions, and 4 with Mallory Weiss tears) to groups that underwent standard, visually guided endoscopic hemostasis (control, n=76) or endoscopic hemostasis assisted by Doppler monitoring of blood flow under the stigmata (n=72). The primary outcome was rate of rebleeding after 30 days; secondary outcomes were complications, death, and need for transfusions, surgery, or angiography.
RESULTS
There was a significant difference in rates of lesion rebleeding within 30 days of endoscopic hemostasis in the control group (26.3%) vs the Doppler group (11.1%) (P=.0214). The odds ratio for rebleeding with Doppler monitoring was 0.35 (95% CI, 0.143–0.8565) and number needed to treat was 7. There were also significant differences in rates of surgery and major complications (5.3% in the control group vs no patients in the Doppler monitoring group for each, P=.048)
CONCLUSIONS
In a randomized controlled trial of patients with severe upper gastrointestinal hemorrhage from ulcers or other lesions, Doppler probe-guided endoscopic hemostasis significantly reduced 30 day rates of rebleeding, surgery, and major complications compared to standard, visually guided hemostasis. Guidelines for non-variceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F)
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