Document Detail


Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers.
MedLine Citation:
PMID:  21086569     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers.
METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding.
RESULTS: A total of 175 patients (144, sustained hemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category III, IV and V), shock, severe anemia (hemoglobin < 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications.
CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.
Authors:
Ming-Luen Hu; Keng-Liang Wu; King-Wah Chiu; Yi-Chun Chiu; Yeh-Pin Chou; Wei-Chen Tai; Tsung-Hui Hu; Shue-Shian Chiou; Seng-Kee Chuah
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of gastroenterology : WJG     Volume:  16     ISSN:  2219-2840     ISO Abbreviation:  World J. Gastroenterol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-18     Completed Date:  2011-04-08     Revised Date:  2014-05-20    
Medline Journal Info:
Nlm Unique ID:  100883448     Medline TA:  World J Gastroenterol     Country:  China    
Other Details:
Languages:  eng     Pagination:  5490-5     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Anemia / complications
Combined Modality Therapy
Electrocoagulation
Epinephrine / pharmacology,  therapeutic use*
Female
Hemostasis / drug effects*
Humans
Male
Middle Aged
Peptic Ulcer Hemorrhage / epidemiology,  therapy*
Predictive Value of Tests
Recurrence
Retrospective Studies
Risk Factors
Stomach Ulcer / complications*
Surgical Instruments
Treatment Outcome
Vasoconstrictor Agents / pharmacology*,  therapeutic use*
Chemical
Reg. No./Substance:
0/Vasoconstrictor Agents; YKH834O4BH/Epinephrine
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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