Comparison between Endoscopic Therapy and Medical Therapy in Peptic Ulcer Patients with Adherent Clot: A Multicenter Prospective Observational Cohort Study.
- Author:
Si Hye KIM
1
;
Jin Tae JUNG
;
Joong Goo KWON
;
Eun Young KIM
;
Dong Wook LEE
;
Seong Woo JEON
;
Kyung Sik PARK
;
Si Hyung LEE
;
Jeong Bae PARK
;
Chang Yoon HA
;
Youn Sun PARK
Author Information
- Publication Type:English Abstract ; Multicenter Study ; Original Article
- Keywords: Peptic ulcer; Bleeding; Mortality; Risk factors
- MeSH: 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
- From:The Korean Journal of Gastroenterology 2015;66(2):98-105
- CountryRepublic of Korea
- Language:Korean
- 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.
