Predictive Factors for Intractability to Endoscopic Hemostasis in the Treatment of Bleeding Gastroduodenal Peptic Ulcers in Japanese Patients.
- Author:
Naotaka OGASAWARA
1
;
Mari MIZUNO
;
Ryuta MASUI
;
Yoshihiro KONDO
;
Yoshiharu YAMAGUCHI
;
Kenichiro YANAMOTO
;
Hisatsugu NODA
;
Noriko OKANIWA
;
Makoto SASAKI
;
Kunio KASUGAI
Author Information
- Publication Type:Original Article
- Keywords: Aged; Cerebro-cardiovascular diseases; Hematemesis; Melena; Shock; Forrest type
- MeSH: Asian Continental Ancestry Group*; Emergencies; Endoscopy; Hematemesis; Hemorrhage*; Hemostasis; Hemostasis, Endoscopic*; Humans; Melena; Mortality; Multivariate Analysis; Peptic Ulcer*; Risk Factors; Serum Albumin; Shock; Ulcer
- From:Clinical Endoscopy 2014;47(2):162-173
- CountryRepublic of Korea
- Language:English
- 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.
