Exposed blood vessels of more than 2 mm in diameter are a risk factor for rebleeding after endoscopic clipping hemostasis for hemorrhagic gastroduodenal ulcer

Ishikawa, Shinya; Inaba, Tomoki; Wato, Masahiro; Takashima, Seisuke; Mizushige, Tomoko; Izumikawa, K.; Miyoshi, Masatsugu; Kawai, Kozo

doi:10.1111/j.1443-1661.2012.01333.x

Cited by 12 publications

(8 citation statements)

References 22 publications

(60 reference statements)

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“…Risk factors for early rebleeding include unstable hemodynamic status, severe anemia (Hb <8 g/dL), active bleeding (Forrest Ia/Ib), large‐sized ulcer >2 cm, hematemesis, and exposed blood vessels >2 mm in diameter. Patients with a white, protruded and peripheral non‐bleeding visible vessel (Forrest IIA) also have a high risk of rebleeding . From the above, second‐look endoscopy should be carried out in patients with a high risk of rebleeding when PPI therapy is given after initial hemostasis (evidence level IVb, recommendation C1).…”

Section: Management Of Patients With Acute Peptic Gastroduodenal Ulcementioning

confidence: 99%

“…Interventional radiology (IVR) or surgery should be carried out in patients with peptic gastroduodenal ulcer bleeding in whom endoscopic hemostasis fails (evidence level IVb, recommendation C1). Large ulcer size and the presence of hypovolemic shock are factors related to failure to achieve hemostasis in patients with recurrent bleeding after initial treatment . IVR for peptic gastroduodenal ulcer bleeding can be done with a high technical success rate (90–100%), but the clinical success rate varies from 50% to 83% .…”

Section: Management Of Patients With Acute Peptic Gastroduodenal Ulcementioning

confidence: 99%

“…Patients with a white, protruded and peripheral non-bleeding visible vessel (Forrest IIA) also have a high risk of rebleeding. [126][127][128][129][130][131][132] From the above, second-look endoscopy should be carried out in patients with a high risk of rebleeding when PPI therapy is given after initial hemostasis (evidence level IVb, recommendation C1).…”

Section: Management After Successful Endoscopic Hemostasismentioning

confidence: 99%

“…Large ulcer size and the presence of hypovolemic shock are factors related to failure to achieve hemostasis in patients with recurrent bleeding after initial treatment. [126][127][128][129][130][131][132] IVR for peptic gastroduodenal ulcer bleeding can be done with a high technical success rate (90-100%), but the clinical success rate varies from 50% to 83%. 135 It should be kept in mind that IVR does not always achieve permanent hemostasis.…”

Section: Management After Successful Endoscopic Hemostasismentioning

confidence: 99%

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Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Fujishiro

Iguchi

Kakushima

et al. 2016

Digestive Endoscopy

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Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding using evidence‐based methods. The major cause of non‐variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug‐related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)‐related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first‐line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research.

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Section: Management Of Patients With Acute Peptic Gastroduodenal Ulcementioning

confidence: 99%

Section: Management Of Patients With Acute Peptic Gastroduodenal Ulcementioning

confidence: 99%

Section: Management After Successful Endoscopic Hemostasismentioning

confidence: 99%

Section: Management After Successful Endoscopic Hemostasismentioning

confidence: 99%

See 2 more Smart Citations

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Fujishiro

Iguchi

Kakushima

et al. 2016

Digestive Endoscopy

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“…The exposed vessel of the third patient had a vascular diameter that greatly exceeded 2 mm. Ishikawa et al previously reported that an exposed blood vessel with a diameter of 2 mm or more was a risk factor for recurrent bleeding [21]. According to Lin et al, the rate of recurrent bleeding is directly correlated with the size of a non-bleeding visible vessel [19].…”

Section: Discussionmentioning

confidence: 99%

Misinterpretation or Underestimation of the Appearance, Location, or Size of Non-bleeding Visible Vessels (Forrest Class IIa) as a Cause of Hemostasis Failure

Kamezaki¹,

Sakamoto²,

Okamura³

et al. 2018

OBM HG

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(1) Background: Endoscopy has become the primary diagnostic and therapeutic technique for non-variceal upper gastrointestinal bleeding. Despite advances in therapeutic methods and instrumentation, endoscopic hemostatic failure occurs in 10% of patients. In this study, we aimed to analyze the endoscopic findings in patients with failed hemostasis and to elucidate strategies for endoscopists and gastroenterologists to facilitate improved treatment outcomes. (2) Methods: A total of 128 patients received hemostatic treatment for non-variceal upper gastrointestinal bleeding. Endoscopic findings in three patients with failed hemostasis after the initial and secondary endoscopies were analyzed. (3) Results: Hemostasis failure occurred in three cases (2.3%). All three cases involved patients with gastric ulcer and were categorized as Forrest class IIa presenting with a non-Page 2/11 bleeding visible vessel in endoscopic findings. Misinterpretation or underestimation of the appearance, location, or size of the vessel resulted in hemostasis failure. (4) Conclusions: Our findings demonstrate that identification of a non-bleeding visible vessels and assessment of the risk of re-bleeding in such vessels is often difficult. Detailed examination of the ulcer floor with awareness of the possibility of a non-bleeding visible vessel will lead to improved hemostatic treatment outcomes. The decision regarding hemostatic treatment of a visible vessel with a diameter exceeding 2 mm should be made cautiously, and treatment should be followed by an appropriate period of fasting prior to endoscopic confirmation of successful hemostasis.

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Bleeding from pancreatic arteriovenous malformation with duodenal ulcer penetration. Case report and literature review

Takayama

Shimodate

Nomura

et al. 2020

Clinical Case Reports

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Exposed blood vessels of more than 2 mm in diameter are a risk factor for rebleeding after endoscopic clipping hemostasis for hemorrhagic gastroduodenal ulcer

Abstract: Endoscopic clipping monotherapy is effective for hemorrhagic gastroduodenal ulcers; however, exposed blood vessels of more than 2 mm in diameter in the initial endoscopic procedure are a risk factor for rebleeding.

Cited by 12 publications

References 22 publications

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Misinterpretation or Underestimation of the Appearance, Location, or Size of Non-bleeding Visible Vessels (Forrest Class IIa) as a Cause of Hemostasis Failure

Bleeding from pancreatic arteriovenous malformation with duodenal ulcer penetration. Case report and literature review

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