An increased knowledge regarding the predictors of rebleeding after endoscopic therapy for bleeding ulcers should improve clinical management and outcomes.
Dr Joseph Elmunzer and colleagues conducted a systematic review to identify the strongest and most consistent predictors of rebleeding to assist in the development of tools to stratify and appropriately manage patients after endoscopic therapy.
The team performed bibliographic database searches for prospective studies assessing rebleeding after endoscopic therapy for bleeding ulcers.
The team identified relevant studies, and data were abstracted in a duplicate and independent fashion.
|Endoscopic predictors of rebleeding was active bleeding at endoscopy|
|American Journal of Gastroenterology|
The primary outcomes sought were significant independent predictors of rebleeding by multivariable analyses in 2 studies.
The researchers identified 10 articles that met the prespecified inclusion criteria.
The pooled rate of rebleeding after endoscopic therapy was 16%.
The independent pre-endoscopic predictors of rebleeding were hemodynamic instability and comorbid illness.
The independent endoscopic predictors of rebleeding included active bleeding at endoscopy.
Large ulcer size, posterior duodenal ulcer, and lesser gastric curvature ulcer were independent endoscopic predictors of rebleeding.
Dr Elmunzer’s team concluded, “The independent predictors of recurrent hemorrhage after endoscopic therapy, particularly those that are the strongest and most consistent in the literature, may be used to select patients who are most likely to benefit from aggressive post-hemostasis care.”
“Including intensive care unit observation and second-look endoscopy.”
“Prospective studies designed to formally assess the relative utilities of these factors in predicting rebleeding and dictating management are needed.”