Korean J Gastroenterol.  2015 Aug;66(2):98-105. 10.4166/kjg.2015.66.2.98.

Comparison between Endoscopic Therapy and Medical Therapy in Peptic Ulcer Patients with Adherent Clot: A Multicenter Prospective Observational Cohort Study

• Kim SH
• Jung JT
• Kwon JG
• Kim EY
• Lee DW
• Jeon SW
• Park KS
• Lee SH
• Park JB
• Ha CY
• Park YS
• Daegu-Gyeongbuk Gastrointestinal Study Group (DGSG)

• KMID: 2373321
• DOI: http://doi.org/10.4166/kjg.2015.66.2.98

Abstract

BACKGROUND/AIMS
The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk factors of rebleeding in Forrest type IIB peptic ulcer.
METHODS
Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December 2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic ulcer with adherent clots were enrolled.
RESULTS
Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs. 10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group. However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641). In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1; p=0.025).
CONCLUSIONS
In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding was use of aspirin and/or NSAID.

Keyword

Peptic ulcer; Bleeding; Mortality; Risk factors

MeSH Terms

Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Aspirin/therapeutic use
Cohort Studies
Female
*Hemostasis, Endoscopic
Humans
Male
Middle Aged
Multivariate Analysis
Peptic Ulcer/complications/diagnosis
Peptic Ulcer Hemorrhage/etiology/*therapy
Prospective Studies
Proton Pump Inhibitors/therapeutic use
Recurrence
Risk Factors
Treatment Outcome
Anti-Inflammatory Agents, Non-Steroidal
Aspirin
Proton Pump Inhibitors

Figure

• 

  Fig. 1. Study flow showing the causes of upper gastrointestinal bleeding. The numbers in parentheses are the proportions of each group relating to patients with upper gastrointestinal bleeding (UGIB). GI, gastrointestinal; NUB, non-peptic ulcer related bleeding; UB, peptic ulcer bleeding.

Reference

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