Document Detail

The non-bleeding visible vessel versus the sentinel clot: natural history and risk of rebleeding.
MedLine Citation:
PMID:  8514066     Owner:  NLM     Status:  MEDLINE    
Non-bleeding visible vessel and sentinel clot are terms used interchangeably to describe protuberances in the base of ulcers that have recently bled, but a consensus as to their definition or natural history does not exist. In patients with severe ulcer hemorrhage, non-bleeding protuberances were classified as vessels, with or without a small attached clot, or as sentinel clots, according to a schema based on the appearance of the protuberance at endoscopy but not subjected to pathologic correlation. Endoscopic therapy was not performed at the index endoscopic evaluation, and natural evolution was prospectively documented with daily videoendoscopy. Eleven (46%) of 24 patients with non-bleeding protuberances had rebleeding. Independent classification by three authors concurred in 18 (75%) of 24 lesions. Ten (91%) of 11 vessels with or without attached clot rebled versus 0 (0%) of 7 sentinel clots and 1 (17%) of 6 lesions without unanimous classification (p < 0.01, vessels versus other groups). Rebleeding occurred in 5 (71%) of 7 nonpigmented (pale or white), 6 (38%) of 16 red or purple, and 0 (0%) of 1 black protuberances. In general, vessels persisted until rebleeding, whereas sentinel clots disappeared within 1 to 3 days. We conclude that nonbleeding protuberances in ulcer bases can be separated into vessels, which have a high risk of rebleeding, and sentinel clots, which have a low risk of rebleeding.
M L Freeman; O W Cass; C J Peine; G R Onstad
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  39     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:    1993 May-Jun
Date Detail:
Created Date:  1993-07-22     Completed Date:  1993-07-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  359-66     Citation Subset:  IM    
Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota 55415.
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MeSH Terms
Blood Coagulation
Blood Vessels / pathology
Duodenal Ulcer / complications*,  pathology
Endoscopy, Digestive System
Middle Aged
Peptic Ulcer Hemorrhage / blood,  epidemiology*,  pathology
Prospective Studies
Risk Factors
Stomach Ulcer / complications*,  pathology
Comment In:
Gastrointest Endosc. 1994 Sep-Oct;40(5):648   [PMID:  7988839 ]
Gastrointest Endosc. 1993 May-Jun;39(3):461-2   [PMID:  8514088 ]

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