Dennis M Jensen1, Thomas O G Kovacs2, Gordon V Ohning2, Kevin Ghassemi3, Gustavo A Machicado2, Gareth S Dulai2, Alireza Sedarat2, Rome Jutabha3, Jeffrey Gornbein4. 1. Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California. Electronic address: djensen@mednet.ucla.edu. 2. Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California. 3. Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. 4. Department of Biomathematics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Abstract
BACKGROUND & AIMS: For 4 decades, stigmata of recent hemorrhage in patients with nonvariceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata rarely is 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 nonvariceal upper gastrointestinal hemorrhage. METHODS: In a single-blind study performed at 2 referral centers we assigned 148 patients with severe nonvariceal upper gastrointestinal bleeding (125 with ulcers, 19 with Dieulafoy's lesions, and 4 with Mallory Weiss tears) to groups that underwentstandard, 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 the 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 the 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% confidence interval, 0.143-0.8565) and the number needed to treat was 7. 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 compared with standard, visually guided hemostasis. Guidelines for nonvariceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F).
RCT Entities:
BACKGROUND & AIMS: For 4 decades, stigmata of recent hemorrhage in patients with nonvariceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata rarely is 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 nonvariceal upper gastrointestinal hemorrhage. METHODS: In a single-blind study performed at 2 referral centers we assigned 148 patients with severe nonvariceal 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 the 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 the 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% confidence interval, 0.143-0.8565) and the number needed to treat was 7. 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 compared with standard, visually guided hemostasis. Guidelines for nonvariceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F).
Authors: Dennis M Jensen; Gordon V Ohning; Thomas O G Kovacs; Kevin A Ghassemi; Rome Jutabha; Gareth S Dulai; Gustavo A Machicado Journal: Gastrointest Endosc Date: 2015-08-28 Impact factor: 9.427
Authors: Alan N Barkun; Marc Bardou; Ernst J Kuipers; Joseph Sung; Richard H Hunt; Myriam Martel; Paul Sinclair Journal: Ann Intern Med Date: 2010-01-19 Impact factor: 25.391
Authors: Dennis M Jensen; Thomas O G Kovacs; Rome Jutabha; Gustavo A Machicado; Ian M Gralnek; Thomas J Savides; James Smith; Mary Ellen Jensen; Gwen Alofaituli; Jeff Gornbein Journal: Gastroenterology Date: 2002-08 Impact factor: 22.682
Authors: Dennis M Jensen; Thomas Kovacs; Kevin A Ghassemi; Marc Kaneshiro; Jeffrey Gornbein Journal: Clin Gastroenterol Hepatol Date: 2020-08-20 Impact factor: 11.382
Authors: Philip C Spinella; Nahed El Kassar; Andrew P Cap; Andrei L Kindzelski; Christopher S Almond; Alan Barkun; Terry B Gernsheimer; Joshua N Goldstein; John B Holcomb; Alfonso Iorio; Dennis M Jensen; Nigel S Key; Jerrold H Levy; Stephan A Mayer; Ernest E Moore; Simon J Stanworth; Roger J Lewis; Marie E Steiner Journal: J Trauma Acute Care Surg Date: 2021-08-01 Impact factor: 3.697
Authors: Alan N Barkun; Majid Almadi; Ernst J Kuipers; Loren Laine; Joseph Sung; Frances Tse; Grigorios I Leontiadis; Neena S Abraham; Xavier Calvet; Francis K L Chan; James Douketis; Robert Enns; Ian M Gralnek; Vipul Jairath; Dennis Jensen; James Lau; Gregory Y H Lip; Romaric Loffroy; Fauze Maluf-Filho; Andrew C Meltzer; Nageshwar Reddy; John R Saltzman; John K Marshall; Marc Bardou Journal: Ann Intern Med Date: 2019-10-22 Impact factor: 25.391
Authors: Dennis M Jensen; Alan Barkun; David Cave; Ian M Gralnek; Rome Jutabha; Loren Laine; James Y W Lau; John R Saltzman; Roy Soetikno; Joseph J Y Sung Journal: Aliment Pharmacol Ther Date: 2021-07-20 Impact factor: 9.524