Risk Factors for Early Rebleeding after Initial Endoscopic Hemostasis in Patients with Bleeding Peptic Ulcers

Park, Jeong Ki; Jung, Ye Dal; Seo, Young Jin; Choi, Byung Ryul; Kweon, Joong Goo; Lee, Chang Hyeong; Kim, Ho Gak; Bae, Jung Dong; Park, Soon Woo

Abstract

BACKGROUND/AIMS
Rebleeding rate after initial endoscopic hemostasis in patients with ulcer hemorrhage has been reported in 20-30%. Identification of patients who are at high risk for rebleeding would be expected to improve the outcome of endoscopic hemostasis. The purpose of this study was to evaluate risk factors for early rebleeding after initial hemostasis in the view of clinical and endoscopic characteristics.
METHODS
We reviewed 99 patients who presented with bleeding peptic ulcers and were treated with endoscopic hemostasis including hypertonic saline injection, electrocautery and clipping. We compared the clinical variables (age, pulse rate, hemoglobin), endoscopic characteristics of ulcer (size, number, and location of ulcer, clots on the base, bleeding stigmata, size and color of exposed vessel) between the patients who bled early (n=22) and who didn't bleed (n=77) within 5 days.
RESULTS
The statistically significant correlates with early rebleeding after hemostasis were number of comorbid illness (> or =2) (p=0.031), volume of transfusion (> or5 units) (p=0.001), size of ulcer (>1 cm) (p=0.038), multiple ulcers (p=0.020), presence of blood clots on ulcer base (p=0.012), stigmata (active bleeding and visible vessels) (p=0.010), size of exposed vessel (>1 mm) (p<0.0001). In multivariate analysis, volume of transfusion (odds ratio[OR] 14.4), size of ulcer (OR 11.7), multiple ulcers (OR 5.5) and size of exposed vessel (OR 13.2) were significant risk factors.
CONCLUSIONS
The risk factors for early rebleeding after hemostasis in bleeding peptic ulcer can be predicted by clinical variables and endoscopic findings. Early identification of risk factors such as transfusion over 5 units, large-sized ulcer, multiple ulcers, bleeding stigmata and size of exposed vessel over 1 mm can predict the prognosis of peptic ulcer bleeding.