Predictive Factors for Intractability to Endoscopic Hemostasis in the Treatment of Bleeding Gastroduodenal Peptic Ulcers in Japanese Patients

Ogasawara, Nagahisa; Mizuno, Mari; Masui, Ryuta; Kondo, Yoshihiro; Yamaguchi, Yoshiharu; Yanamoto, Kenichiro; Noda, Hisatsugu; Okaniwa, Noriko; Sasaki, Makoto; Kasugai, Kunio

doi:10.5946/ce.2014.47.2.162

Cited by 20 publications

(25 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, unsuccessful endoscopic hemostasis was found to be an independent risk factor for rebleeding and was associated with increased 30-d mortality in patients with NVGIB[17,29,30]. These findings support the role of a primary effective endoscopic hemostasis.…”

Section: Discussionmentioning

confidence: 77%

First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high-risk gastrointestinal bleeding: A single-center experience with 100 cases

Richter-Schrag¹,

Glatz²,

Walker³

et al. 2016

WJG

View full text Add to dashboard Cite

AIMTo evaluate rebleeding, primary failure (PF) and mortality of patients in whom over-the-scope clips (OTSCs) were used as first-line and second-line endoscopic treatment (FLET, SLET) of upper and lower gastrointestinal bleeding (UGIB, LGIB).METHODSA retrospective analysis of a prospectively collected database identified all patients with UGIB and LGIB in a tertiary endoscopic referral center of the University of Freiburg, Germany, from 04-2012 to 05-2016 (n = 93) who underwent FLET and SLET with OTSCs. The complete Rockall risk scores were calculated from patients with UGIB. The scores were categorized as < or ≥ 7 and were compared with the original Rockall data. Differences between FLET and SLET were calculated. Univariate and multivariate analysis were performed to evaluate the factors that influenced rebleeding after OTSC placement.RESULTSPrimary hemostasis and clinical success of bleeding lesions (without rebleeding) was achieved in 88/100 (88%) and 78/100 (78%), respectively. PF was significantly lower when OTSCs were applied as FLET compared to SLET (4.9% vs 23%, P = 0.008). In multivariate analysis, patients who had OTSC placement as SLET had a significantly higher rebleeding risk compared to those who had FLET (OR 5.3; P = 0.008). Patients with Rockall risk scores ≥ 7 had a significantly higher in-hospital mortality compared to those with scores < 7 (35% vs 10%, P = 0.034). No significant differences were observed in patients with scores < or ≥ 7 in rebleeding and rebleeding-associated mortality.CONCLUSIONOur data show for the first time that FLET with OTSC might be the best predictor to successfully prevent rebleeding of gastrointestinal bleeding compared to SLET. The type of treatment determines the success of primary hemostasis or primary failure.

show abstract

Section: Discussionmentioning

confidence: 77%

First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high-risk gastrointestinal bleeding: A single-center experience with 100 cases

Richter-Schrag¹,

Glatz²,

Walker³

et al. 2016

WJG

View full text Add to dashboard Cite

show abstract

“…In addition the eradication of helicobacter pylori has decreased incidence rates of gastric and duodenal ulcers 1. Although the number of hospitalizations due to peptic ulcer disease has decreased during the last decades 2, in contrast to this nationwide trend, admission rates for gastric and duodenal ulcer hemorrhage and perforation in older patients even increased 3 and mortality rates remained essentially unchanged at 5 % to 8 % 4. This may in part be due to the increasing and intensive use of antithrombotic and/or anticoagulant medications for treatment of various cardiac, vascular or circulatory disorders in a consistently older population of patients with multiple morbidities 5 6.…”

Section: Introductionmentioning

confidence: 99%

Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

et al. 2017

View full text Add to dashboard Cite

Background and study aims In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding. Success rates with the first endoscopic therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy were analyzed retrospectively. Results Application of the OTSC resulted in immediate hemostasis (primary success rate) in all 75 patients. However, in 34.7 % a rebleeding episode was noted that could be treated by further endoscopic interventions. Only 3 patients had to be sent to the operating room because of failure of endoscopic therapy. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs. 48.9 %). Conclusions Application of the OTSC in GI bleeding results in a high rate of primary hemostasis. Rebleeding occurs in up to 35 % of patients receiving antithrombotic/anticoagulant therapy but can be managed successfully with further endoscopic treatments. Patients in the rebleeding group were more frequently treated with antiplatelet agents. Radiological or surgical therapy was reserved for a small subgroup not successfully managed by repeated endoscopic therapies. OTSC application is the treatment of choice in high-risk patients when conventional clips used as first-line treatment fail.

show abstract

“…[18] In the study by Ogasawara et al, [19] age ≥70 years, shock on admission, Hb <8.0 g/L, serum [14] that for a patient with American Society of Anesthesiologists (ASA) score 3 to 5, Hb <70 g/L, and endoscopy within 12 hours, the probability of finding high-risk NVUGIB would be 58%. In 2014, Giese et al [20] concluded that in patients with UGIB subject to after-hours endoscopy, a "high-risk" Rockall score permitted an estimation of the risk of death within 30 days, but not of rebleeding.…”

Section: Discussionmentioning

confidence: 99%

Simple Risk Factors to Predict Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Bleeding Pre-endoscopically

Wang

Tang

et al. 2017

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

Predictive Factors for Intractability to Endoscopic Hemostasis in the Treatment of Bleeding Gastroduodenal Peptic Ulcers in Japanese Patients

Cited by 20 publications

References 27 publications

First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high-risk gastrointestinal bleeding: A single-center experience with 100 cases

First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high-risk gastrointestinal bleeding: A single-center experience with 100 cases

Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

Simple Risk Factors to Predict Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Bleeding Pre-endoscopically

Contact Info

Product

Resources

About