| Predictors of hemostatic failure after adrenaline injection in patients with peptic ulcers with non-bleeding visible vessel. | |
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MedLine Citation:
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PMID: 15223687 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Non-bleeding visible vessel (NBVV) in patients with bleeding peptic ulcer is associated with a high risk of rebleeding. The aim of this study was to define factors associated with failure of endoscopic hemostasis and rebleeding in patients with NBVV. METHODS: Clinical and endoscopic parameters related to failure of endoscopic hemostasis with adrenaline in 191 bleeding peptic ulcer patients with NBVV were evaluated. RESULTS: Endoscopic hemostasis was permanently successful in 154 patients (80.6%). Emergency surgical hemostasis for rebleeding was required in 37 patients (19.4%). Univariate analysis showed that therapeutic failure was significantly related to the presence of shock on admission (P=0.003), posterior duodenal ulcers (P=0.001), peptic ulcer history (P=0.001), previous peptic ulcer bleeding (P=0.002), or lack of history of non-steroidal anti-inflammatory drugs consumption, when compared to use of such drugs (P=0.04). Patients where therapy failed had lower hemoglobin levels at admission (7.8+/-1.9 g/dL versus 10+/-2.4 g/dL, P=0.005). In a multivariate analysis low hemoglobin (P<0.001) as well as history of previous peptic ulcer bleeding (P=0.002) and posterior duodenal ulcers (P=0.001) were negative predictors. Using the mean value of hemoglobin as the cut-off point, it is noteworthy that only 2 out of 81 patients (2.5%) who had none of these predictive factors required emergency surgical hemostasis, whereas 34 out of 110 patients (30.9%) with at least one predictive factor required emergency surgery. CONCLUSION: It is possible, by employing specific characteristics, to define a subgroup of high-risk patients for rebleeding in patients with NBVV despite therapeutic endoscopy and thus candidates for a complementary endoscopic method of hemostasis or emergency surgical intervention. |
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Authors:
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K C Thomopoulos; G J Theocharis; K A Vagenas; D D Danikas; C E Vagianos; V N Nikolopoulou |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Scandinavian journal of gastroenterology Volume: 39 ISSN: 0036-5521 ISO Abbreviation: Scand. J. Gastroenterol. Publication Date: 2004 Jun |
Date Detail:
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Created Date: 2004-06-29 Completed Date: 2004-11-02 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0060105 Medline TA: Scand J Gastroenterol Country: Norway |
Other Details:
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Languages: eng Pagination: 600-4 Citation Subset: IM |
Affiliation:
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Dept. of Internal Medicine, Division of Gastroenterology, Rion University Hospital, Patras, Greece. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Epinephrine / administration & dosage* Female Hemostasis, Endoscopic* Humans Injections, Intralesional Male Middle Aged Peptic Ulcer Hemorrhage / pathology, therapy* Recurrence Risk Factors Treatment Failure Vasoconstrictor Agents / administration & dosage* |
| Chemical | |
Reg. No./Substance:
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0/Vasoconstrictor Agents; 51-43-4/Epinephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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