Predictors of rebleeding after endoscopic haemostasis of bleeding peptic ulcers

Abstract EN

The effectiveness of endoscopic manipulation in the control of bleeding in peptic ulcers have been established and currently early endoscopy is the best management for acute ulcer bleeding .During endoscopy we can identify the bleeding site and stratify the risk of recurrent bleeding.

Aim of the work: to study endoscopic findings as factors for prediction of rebleeding after endoscopic hemostasis of bleeding peptic ulcers.

These factors were evaluated versus clinical factors.

Subjects and Methods: This study was performed in Assuit University Hospital, and included 71cases with bleeding peptic ulcer.All patients were subjected to thorough history and clinical examination ,written consent,laboratory investigations as liver functions,prothrombin time and full blood count, and upper endoscopy.

Results: Initial hemostasis was achieved in 67(94.4%) cases while permanent hemostasis in 63(88.7%) cases.

20(28.2%) cases experienced rebleeding.

The risk factors for rebleeding were age above 55 years 11(55%) and shock at the onset of bleeding which was observed in 19(95%) rebleeders.

Endoscopic evaluation revealed that duodenal ulcer was observed more than gastric ulcer in the rebleeder as 12(60%)cases had duodenal ulcer versus 8(40%) had gastric ulcer.

Also, the presence of the ulcer in the posterior wall of the duodenum 10 (83.3%) compared to only 2(12.7%) in the anterior wall was statistically significant P<0.00.Spurting was detected in 8(40%>) of rebleeding cases and in one (1%) case in the patients who did not rebleed with a highly statistical significant P<0.000.

The ulcer size was >1.5 cm in 14(70%) out of the 20 bleeders and <1.5 cm in 6(30%) of them with statistical significance P--0.0I.

On the other hand other f actors as the shape, depth, vessel color, shape of margin and color of ulcer base showed no statistical significance.on performing multiregression analysis the risk fators for rebleeding included the site of the ulcer being more in the rebleeders in case of duodenal ulcer especially in the posterior wall P<0.001 and the presence of spurting as a risk for rebleeding P<0.001.

Conclusion:Age above 55 years, shock on admission are important predictors of rebleeding after endoscopic hemostasis of bleeding ulcers but endoscopic features as type of ulcer, size and site of ulcer and spurting activity are more important predictors of re-bleeding after endoscopic hemostasis.