The team determined factors predicting treatment failure with combined adrenaline injection and heater probe thermocoagulation in patients with bleeding peptic ulcer.
The findings of the study were published in the March issue of Gut.
Consecutive patients with bleeding peptic ulcers, who received endoscopic therapy between January 1995 and March 1998, were studied.
Data on clinical presentation, endoscopic findings, and treatment outcomes were collected prospectively.
Multiple logistic regression analysis was used to identify independent risk factors for treatment failure.
During the study period, 3386 patients were admitted with bleeding peptic ulcers. Of these, 1144 (796 men, mean age of 63 years) required endoscopic treatment.
There were 666 duodenal ulcers (58%), 425 gastric ulcers (37%), and 53 anastomotic ulcers (5%).
The researchers found that initial hemostasis was successful in 1128 patients (99%).
|Factors predicting rebleeding:|
- Hemoglobin level < 10 g/dl
- Fresh blood in stomach
- Ulcer with active bleeding
- Large ulcers
Among them, 94 (8%) rebled in a median time of 48 hours.
Overall failure rate was 10%, and the mortality rate was 5%.
Multiple logistic regression analysis revealed that hypotension (odds ratio (OR) 2.21), hemoglobin level less that 10 g/dl (OR 1.87), fresh blood in the stomach (OR 2.15), ulcer with active bleeding (OR 1.65), and large ulcers (OR 1.80) were all independent factors predicting rebleeding.
Author S. K. H. Wong, of the Department of Surgery at the Chinese University of Hong Kong, Prince of Wales Hospital, concluded on behalf of the group, "Larger ulcers with severe bleeding at presentation predict failure of endoscopic therapy."