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Clinical Outcomes and Risk Factors of Rebleeding Following Endoscopic Therapy for Nonvariceal Upper Gastrointestinal Hemorrhage

  • Suk, Ki-Tae (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Kim, Hyun-Soo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Lee, Chang-Seob (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Lee, Il-Young (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Kim, Moon-Young (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Kim, Jae-Woo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Baik, Soon-Koo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Kwon, Sang-Ok (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Lee, Dong-Ki (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Ham, Young-Lim (Department of Emergency Medical Technology, Daewon University College)
  • Published : 2011.12.30

Abstract

Background/Aims: Rebleeding after endoscopic therapy for non-variceal upper gastrointestinal hemorrhage (NGIH) is the most important predictive factor of mortality. We evaluated the risk factors of rebleeding in patients undergoing endoscopic therapy for the NGIH. Methods: Between January 2003 and January 2007, 554 bleeding events in 487 patients who underwent endoscopic therapy for NGIH were retrospectively enrolled. We reviewed the clinicoendoscopical characteristics of patients with rebleeding and compared them with those of patients without rebleeding. Results: The incidence of rebleeding was 21.7% (n=120). In the multivariate analysis, initial hemoglobin level ${\leq}$9 g/dL (p=0.002; odds ratio [OR], 2.433), inexperienced endoscopist with less than 2 years of experience in therapeutic endoscopy (p=0.001; OR, 2.418), the need for more 15 cc of epinephrine (p=0.001; OR, 2.570), injection therapy compared to thermal and injection therapy (p=0.001; OR, 2.840), and comorbidity with chronic renal disease (p=0.004; OR, 2.908) or liver cirrhosis (p=0.010; OR, 2.870) were risk factors for rebleeding following endoscopic therapy. Conclusions: Together with patients with low hemoglobin level at presentation, chronic renal disease, liver cirrhosis, the need for more 15 cc of epinephrine, or therapy done by inexperienced endoscopist were risk factors for the development of rebleeding.

Keywords

References

  1. Barkun A, Bardou M, Marshall JK; Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003;139:843-857. https://doi.org/10.7326/0003-4819-139-10-200311180-00012
  2. Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med 1994;331: 717-727. https://doi.org/10.1056/NEJM199409153311107
  3. Müller T, Barkun AN, Martel M. Non-variceal upper GI bleeding in patients already hospitalized for another condition. Am J Gastroenterol 2009; 104:330-339. https://doi.org/10.1038/ajg.2008.62
  4. Chiu PW, Joeng HK, Choi CL, Kwong KH, Ng EK, Lam SH. Predictors of peptic ulcer rebleeding after scheduled second endoscopy: clinical or endoscopic factors? Endoscopy 2006;38:726-729. https://doi.org/10.1055/s-2006-925179
  5. Lin HJ, Lo WC, Lee FY, Perng CL, Tseng GY. A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy. Arch Intern Med 1998;158:54-58. https://doi.org/10.1001/archinte.158.1.54
  6. Wong SK, Yu LM, Lau JY, et al. Prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer. Gut 2002;50:322-325. https://doi.org/10.1136/gut.50.3.322
  7. Kaviani MJ, Hashemi MR, Kazemifar AR, et al. Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical trial. Aliment Pharmacol Ther 2003;17:211-216. https://doi.org/10.1046/j.1365-2036.2003.01416.x
  8. Chan FK, Ching JY, Hung LC, et al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 2005;352:238-244. https://doi.org/10.1056/NEJMoa042087
  9. Chiu PW, Ng EK, Cheung FK, et al. Predicting mortality in patients with bleeding peptic ulcers after therapeutic endoscopy. Clin Gastroenterol Hepatol 2009;7:311-316. https://doi.org/10.1016/j.cgh.2008.08.044
  10. Wolf AT, Wasan SK, Saltzman JR. Impact of anticoagulation on rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage. Am J Gastroenterol 2007;102:290-296. https://doi.org/10.1111/j.1572-0241.2006.00969.x
  11. Tajima A, Koizumi K, Suzuki K, et al. Proton pump inhibitors and recurrent bleeding in peptic ulcer disease. J Gastroenterol Hepatol 2008;23 Suppl 2:S237-S241. https://doi.org/10.1111/j.1440-1746.2008.05557.x
  12. Andriulli A, Annese V, Caruso N, et al. Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta-analyses. Am J Gastroenterol 2005;100:207-219. https://doi.org/10.1111/j.1572-0241.2005.40636.x
  13. Lau JY, Sung JJ, Lee KK, et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med 2000;343:310-316. https://doi.org/10.1056/NEJM200008033430501
  14. Ng FH, Wong SY, Lam KF, et al. Gastrointestinal bleeding in patients receiving a combination of aspirin, clopidogrel, and enoxaparin in acute coronary syndrome. Am J Gastroenterol 2008;103:865-871. https://doi.org/10.1111/j.1572-0241.2007.01715.x
  15. Marmo R, Koch M, Cipolletta L, et al. Predictive factors of mortality from nonvariceal upper gastrointestinal hemorrhage: a multicenter study. Am J Gastroenterol 2008;103:1639-1647. https://doi.org/10.1111/j.1572-0241.2008.01865.x
  16. Sung JJ, Barkun A, Kuipers EJ, et al. Intravenous esomeprazole for prevention of recurrent peptic ulcer bleeding: a randomized trial. Ann Intern Med 2009;150:455-464. https://doi.org/10.7326/0003-4819-150-7-200904070-00105
  17. Cheung J, Yu A, LaBossiere J, Zhu Q, Fedorak RN. Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease. Gastrointest Endosc 2010;71:44-49. https://doi.org/10.1016/j.gie.2009.04.014
  18. Dinoso VP Jr, Murthy SN, Saris AL, et al. Gastric and pancreatic function in patients with end-stage renal disease. J Clin Gastroenterol 1982;4: 321-324. https://doi.org/10.1097/00004836-198208000-00005
  19. Hu ML, Wu KL, Chiu KW, et al. Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers. World J Gastroenterol 2010;16:5490-5495. https://doi.org/10.3748/wjg.v16.i43.5490
  20. Vallurupalli NG, Goldhaber SZ. Gastrointestinal complications of dual antiplatelet therapy. Circulation 2006;113:e655-e658. https://doi.org/10.1161/CIRCULATIONAHA.105.590612
  21. Peters RJ, Mehta SR, Fox KA, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation 2003;108:1682-1687. https://doi.org/10.1161/01.CIR.0000091201.39590.CB
  22. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010;152:101-113. https://doi.org/10.7326/0003-4819-152-2-201001190-00009

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