OBJECTIVES: The role of therapeutic endoscopy in bleeding peptic ulcer is well documented. Nevertheless, failures of endoscopic therapy occur, and such patients could be put at an increased risk of death by delays in definitive surgery. The aim of this study was to define factors associated with failed endoscopic therapy. METHODS:Endoscopic intervention was attempted in 326 consecutive patients presenting with bleeding peptic ulcer using injection or heater probe therapy. RESULTS:Endoscopic therapy was possible in 308 (94%) patients, and permanent hemostasis was achieved in 269 (82.5%) of these. Fifty-seven (17.5%) patients continued to bleed or rebled in hospital. Patients who presented with active hemorrhage, shock on admission, and the lowest hemoglobin concentration did less well than those without these risk factors (p < 0.001). A history of nonsteroidal anti-inflammatory drugs or aspirin usage, coagulopathy, previous peptic ulceration, and concomitant cardiorespiratory disease did not predict outcome of endoscopic therapy. Age of the patient was not an independent risk factor for outcome of therapy. The position of a gastric ulcer did not affect outcome, but a posterior duodenal ulcer was significantly more often associated with failed endoscopic therapy than was the case with an anterior ulcer (p = 0.02). CONCLUSION:Endoscopic interventional treatment should be offered to all high-risk bleeding ulcer patients; no subgroup of patients unlikely to benefit from therapy could be identified.
RCT Entities:
OBJECTIVES: The role of therapeutic endoscopy in bleeding peptic ulcer is well documented. Nevertheless, failures of endoscopic therapy occur, and such patients could be put at an increased risk of death by delays in definitive surgery. The aim of this study was to define factors associated with failed endoscopic therapy. METHODS: Endoscopic intervention was attempted in 326 consecutive patients presenting with bleeding peptic ulcer using injection or heater probe therapy. RESULTS: Endoscopic therapy was possible in 308 (94%) patients, and permanent hemostasis was achieved in 269 (82.5%) of these. Fifty-seven (17.5%) patients continued to bleed or rebled in hospital. Patients who presented with active hemorrhage, shock on admission, and the lowest hemoglobin concentration did less well than those without these risk factors (p < 0.001). A history of nonsteroidal anti-inflammatory drugs or aspirin usage, coagulopathy, previous peptic ulceration, and concomitant cardiorespiratory disease did not predict outcome of endoscopic therapy. Age of the patient was not an independent risk factor for outcome of therapy. The position of a gastric ulcer did not affect outcome, but a posterior duodenal ulcer was significantly more often associated with failed endoscopic therapy than was the case with an anterior ulcer (p = 0.02). CONCLUSION: Endoscopic interventional treatment should be offered to all high-risk bleeding ulcerpatients; no subgroup of patients unlikely to benefit from therapy could be identified.
Authors: David Guinier; Nicolas Destrumelle; Pierre Olivier Denue; Pierre Mathieu; Bruno Heyd; Georges Andre Mantion Journal: World J Surg Date: 2009-05 Impact factor: 3.352