Prediction of rebleeding in peptic ulcers by visual stigmata and endoscopic Doppler ultrasound criteria.

Following peptic ulcer hemorrhage, the ability to accurately determine those patients at highest risk of rebleeding relies on clinical and endoscopic criteria which are accurate in only a variable proportion of cases. In this study we have assessed prediction of rebleeding in peptic ulcers using a transendoscopic vascular detector (TVD) to compare the presence of a positive Doppler signal in relation to an ulcer base with visual stigmata of recent hemorrhage (SRH). Of 711 patients endoscoped for upper GI hemorrhage over an 18-month period 180 (25%) were found to have a peptic ulcer. One hundred and twenty-four had either minor or no SRH at the time of endoscopy, and none of these patients rebled. Fifty-six patients had a single peptic ulcer with either active hemorrhage, a visible vessel or adherent clot, and 22 were entered into the trial. Overall, 9 patients (41%) in this group rebled. Considering prediction of rebleeding, visible vessels had a sensitivity of 89% and specificity of 92% compared with a positive Doppler signal sensitivity of 87% and specificity of 86%. These results suggest that the TVD can predict rebleeding in peptic ulcers with an accuracy similar to that of endoscopic identification of a visible vessel.