Prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer

Abstract

Background: Continued or recurrent bleeding after endoscopic treatment for bleeding ulcer is a major adverse prognostic factor. Identification of such ulcers may allow for alternate treatments. Aim: To determine factors predicting treatment failure with combined adrenaline injection and heater probe thermocoagulation. Methods: Consecutive patients with bleeding peptic ulcers who received endoscopic therapy between January 1995 and March 1998 were studied. Data on clinical presentation, endoscopic findings, and treatment outcomes were collected prospectively. Multiple logistic regression analysis was used to identify independent risk factors for treatment failure. Results: During the study period, 3386 patients were admitted with bleeding peptic ulcers: 1144 (796 men, 348 women) with a mean age of 62.5 (SD 17.6) years required endoscopic treatment. There were 666 duodenal ulcers (58.2%), 425 gastric ulcers (37.2%), and 53 anastomotic ulcers (4.6%). Initial haemostasis was successful in 1128 patients (98.6%). Among them, 94 (8.2%) rebled in a median time of 48 hours (range 3-480). Overall failure rate was 9.6%. Mortality rate was 5% (57/ 1144). Multiple logistic regression analysis revealed that hypotension (odds ratio (OR) 2.21, 95% confidence interval (CI) 1.40-3.48), haemoglobin level less that 10 g/dl (OR 1.87, 95% CI 1.18-2.96), fresh blood in the stomach (OR 2.15, 95% CI 1.40-3.31), ulcer with active bleeding (OR 1.65, 95% CI 1.07-2.56), and large ulcers (OR 1.80, 95% CI 1.15-2.83) were independent factors predicting rebleeding. Conclusions: Larger ulcers with severe bleeding at presentation predict failure of endoscopic therapy.

Surgical Salvage of Bleeding Peptic Ulcers after Failed Therapeutic Endoscopy

“…These patients who sustained rebleeding are likely to be poor surgical candidates [17, 18]. These ulcers would also be large in size, located in difficult areas and bleeding from a major vessel with a size >2 mm [17, 19, 20]. The reported mortality for salvage surgery can be up to 20% [21, 22].…”

The influence of feeding on gastric acid suppression in Helicobacter pylori -positive patients treated with a proton pump inhibitor or an H 2 -receptor antagonist after bleeding from a gastric ulcer

“…Moreover, the severity of gastric ulcer affects the rate of the rebleeding. 18 Ulcers most likely to rebleed after endoscopic therapy are greater than 2 cm in diameter and exhibit oozing or spurting of blood. 19 Combination endoscopic therapy of nonbleeding adherent clots significantly reduced early ulcer rebleeding rates in high-risk patients compared with medical therapy alone.…”

Admission risk markers for upper gastrointestinal bleeding: Can urgent endoscopy be avoided?

“…For centers not able to perform urgent endoscopy, the current choice is between admission to hospital followed by 'acute, non-urgent' endoscopy, and discharge from hospital followed by 'early' endoscopy. For the 11,12 suggesting that discharge after endoscopy and at least 48 h of observation could be appropriate.…”