Predictors of hemostatic failure after adrenaline injection in patients with peptic ulcers with non-bleeding visible vessel

• Published in: Scandinavian journal of gastroenterology Vol. 39; no. 6; pp. 600 - 604
• Main Authors: Thomopoulos, K. C., Theocharis, G. J., Vagenas, K. A., Danikas, D. D., Vagianos, C. E., Nikolopoulou, V. N.
• Format: Journal Article
• Language: English
• Published: Copenhagen Informa UK Ltd 01-06-2004; Oslo Taylor & Francis; Stockholm Scandinavian University Press
• Subjects: Adrenaline injection; Adult; Aged; Biological and medical sciences; endoscopic hemostasis; Epinephrine - administration & dosage; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hemostasis, Endoscopic; Humans; Injections, Intralesional; Male; Medical sciences; Middle Aged; non-bleeding visible vessel; Other diseases. Semiology; peptic ulcer bleeding; Peptic Ulcer Hemorrhage - pathology; Peptic Ulcer Hemorrhage - therapy; rebleeding; Recurrence; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Failure; Vasoconstrictor Agents - administration & dosage; Human; Hemostatic; Prediction; Peptic ulcer; Injection; Hemorrhage; endoscopic hemostasis; Gastroduodenal; non-bleeding visible vessel: peptic ulcer bleeding; Blood vessel; Gastroenterology; Digestive diseases; Intestinal disease; rebleeding; Predictive factor; Adrenaline injection; Failure; Gastric disease
• ISSN: 0036-5521; 1502-7708
• DOI: 10.1080/00365520410004631

Background: Non-bleeding visible vessel (NBVV) in patients with bleeding peptic ulcer is associated with a high risk of rebleeding. The aim of this study was to define factors associated with failure of endoscopic hemostasis and rebleeding in patients with NBVV. Methods: Clinical and endoscopic parameters related to failure of endoscopic hemostasis with adrenaline in 191 bleeding peptic ulcer patients with NBVV were evaluated. Results: Endoscopic hemostasis was permanently successful in 154 patients (80.6%). Emergency surgical hemostasis for rebleeding was required in 37 patients (19.4%). Univariate analysis showed that therapeutic failure was significantly related to the presence of shock on admission (P = 0.003), posterior duodenal ulcers (P = 0.001), peptic ulcer history (P = 0.001), previous peptic ulcer bleeding (P = 0.002), or lack of history of non-steroidal anti-inflammatory drugs consumption, when compared to use of such drugs (P = 0.04). Patients where therapy failed had lower hemoglobin levels at admission (7.8 ± 1.9 g dL versus 10 ± 2.4 g dL, P = 0.005). In a multivariate analysis low hemoglobin (P < 0.001) as well as history of previous peptic ulcer bleeding (P = 0.002) and posterior duodenal ulcers (P = 0.001) were negative predictors. Using the mean value of hemoglobin as the cut-off point, it is noteworthy that only 2 out of 81 patients (2.5%) who had none of these predictive factors required emergency surgical hemostasis, whereas 34 out of 110 patients (30.9%) with at least one predictive factor required emergency surgery. Conclusion: It is possible, by employing specific characteristics, to define a subgroup of high-risk patients for rebleeding in patients with NBVV despite therapeutic endoscopy and thus candidates for a complementary endoscopic method of hemostasis or emergency surgical intervention.