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 26 May 2018

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News

Risk assessment and prediction of re-bleeding in gastroduodenal ulcers

An Italian research team finds that a prognostic score, easily obtained after emergency endoscopy, is useful in identifying patients with risk of gastroduodenal ulcer re-bleeding.

News image

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In this study, published in the October issue of Endoscopy, researchers sought to identify risk factors for recurring hemorrhage in bleeding gastroduodenal ulcers after endoscopic injection therapy.

In addition, they aimed to develop a prognostic score that could be used to assess the early risk of re-bleeding.

This study involved 738 patients who all suffered acute bleeding peptic ulcer.

Forrest classification an important predictor of ulcer re-bleeding.
Endoscopy

They had undergone endoscopic examination between 1995 and 1998.

The team treated any ulcers with active bleeding or signs of recent bleeding using injection therapy (epinephrine (1/10,000) and 1% polidocanol).

Multivariate analysis identified a number of predictive variables for the recurrence of hemorrhage.

These were liver cirrhosis, recent surgery, systolic blood pressure, hematemesis, and Forrest classification, as well as the site and size of the ulcer.

The team found that, of these variables, Forrest classification was the most important.

The team's model exhibited a greater sensitivity to re-bleeding occurring within 48 hours, than over a longer period (90% compared to 65%).

Researchers developed prognostic scores in order to allocate patients to one of four risk classes: very low (VL), low (L), high (H), and very high (VH).

They found that the re-bleeding rates for the four classes were 0%, 8%, 32%, and 68%, and that the mortality rates were 6%, 9%, 14%, and 36%, respectively.

They also identified the residual risk of re-bleeding after 48 hours to be 0%, 3%, 10%, and 14% in the four classes. After 5 days the residual risk was under 4% in all classes.

In conclusion, Dr Guglielmi's team states, "This study demonstrates that the proposed prognostic score is useful in clinical practice because it can identify patients with different levels of re-bleeding risk".

"It may be helpful in patient management and decision-making for discharge".

Endoscopy 2002; 10: 778-86
08 October 2002

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