Clin Endosc.  2014 Mar;47(2):162-173. 10.5946/ce.2014.47.2.162.

Predictive Factors for Intractability to Endoscopic Hemostasis in the Treatment of Bleeding Gastroduodenal Peptic Ulcers in Japanese Patients

• Ogasawara
• Mizuno M
• Masui R
• Kondo Y
• Yamaguchi
• Yanamoto K
• Noda H
• Okaniwa N
• Sasaki M
• Kasugai K

• KMID: 2049004
• DOI: http://doi.org/10.5946/ce.2014.47.2.162

Abstract

BACKGROUND/AIMS
Despite improvements in endoscopic hemostasis and pharmacological therapies, upper gastrointestinal (UGI) ulcers repeatedly bleed in 10% to 20% of patients, and those without early endoscopic reintervention or definitive surgery might be at a high risk for mortality. This study aimed to identify the risk factors for intractability to initial endoscopic hemostasis.
METHODS
We analyzed intractability among 428 patients who underwent emergency endoscopy for bleeding UGI ulcers within 24 hours of arrival at the hospital.
RESULTS
Durable hemostasis was achieved in 354 patients by using initial endoscopic procedures. Sixty-nine patients with Forrest types Ia, Ib, IIa, and IIb at the second-look endoscopy were considered intractable to the initial endoscopic hemostasis. Multivariate analysis indicated that age > or =70 years (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.07 to 4.03), shock on admission (OR, 5.26; 95% CI, 2.43 to 11.6), hemoglobin <8.0 mg/dL (OR, 2.80; 95% CI, 1.39 to 5.91), serum albumin <3.3 g/dL (OR, 2.23; 95% CI, 1.07 to 4.89), exposed vessels with a diameter of > or =2 mm on the bottom of ulcers (OR, 4.38; 95% CI, 1.25 to 7.01), and Forrest type Ia and Ib (OR, 2.21; 95% CI, 1.33 to 3.00) predicted intractable endoscopic hemostasis.
CONCLUSIONS
Various factors contribute to intractable endoscopic hemostasis. Careful observation after endoscopic hemostasis is important for patients at a high risk for incomplete hemostasis.

Keyword

Aged; Cerebro-cardiovascular diseases; Hematemesis; Melena; Shock; Forrest type

MeSH Terms

Asian Continental Ancestry Group*
Emergencies
Endoscopy
Hematemesis
Hemorrhage*
Hemostasis
Hemostasis, Endoscopic*
Humans
Melena
Mortality
Multivariate Analysis
Peptic Ulcer*
Risk Factors
Serum Albumin
Shock
Ulcer
Serum Albumin

Figure

• 

  Fig. 1 Prognosis of 428 patients who underwent endoscopic hemostasis. Process of patients and procedures after initial endoscopic hemostasis. a)Three patients underwent emergency surgery because bleeding from vessels associated with upper gastrointestinal did not stop after an initial endoscopic hemostatic procedure. b)Two patients died of cerebral infarction before a scheduled or emergency second-look endoscopy. c)Sixty-nine of 423 patients (16.3%) had Ia, Ib, IIa, or IIb vessels that were considered intractable to the initial endoscopic hemostatic procedure at a scheduled or emergency second-look endoscopy, and they required second endoscopic hemostasis. d)Three hundred fifty-four of 423 patients (83.7%) with Forrest class IIc or III at a scheduled or emergency second-look endoscopy had durable hemostasis. Initial endoscopic hemostatic procedure was considered successful for these patients.

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