| Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers. | |
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MedLine Citation:
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PMID: 21086569 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: World journal of gastroenterology : WJG Volume: 16 ISSN: 1007-9327 ISO Abbreviation: World J. Gastroenterol. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-18 Completed Date: 2011-04-08 Revised Date: 2013-05-27 |
Medline Journal Info:
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Nlm Unique ID: 100883448 Medline TA: World J Gastroenterol Country: China |
Other Details:
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Languages: eng Pagination: 5490-5 Citation Subset: IM |
Affiliation:
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Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Song Hsiang 833, Kaohsiung, Taiwan. |
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Vasoconstrictor Agents; 51-43-4/Epinephrine |
| Comments/Corrections | |
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