Doppler endoscopic probe as a guide to risk stratification and definitive hemostasis of peptic ulcer bleeding - 02/06/16
Abstract |
Background and Aims |
For more than 4 decades endoscopists have relied on ulcer stigmata for risk stratification and as a guide to hemostasis. None used arterial blood flow underneath stigmata to predict outcomes. For patients with severe peptic ulcer bleeding (PUB), we used a Doppler endoscopic probe (DEP) for (1) detection of blood flow underlying stigmata of recent hemorrhage (SRH), (2) quantitating rates of residual arterial blood flow under SRH after visually directed standard endoscopic treatment, and (3) comparing risks of rebleeding and actual 30-day rebleed rates for spurting arterial bleeding (Forrest [F] IA) and oozing bleeding (F IB).
Methods |
Prospective cohort study of 163 consecutive patients with severe PUB and different SRH.
Results |
All blood flow detected by the DEP was arterial. Detection rates were 87.4% in major SRH—spurting arterial bleeding (F IA), non-bleeding visible vessel (F IIA), clot (F IIB)—and were significantly lower at 42.3% (P < .0001) for an intermediate group of oozing bleeding (F IB) or flat spot (F IIC). For spurting bleeding (F IA) versus oozing (F IB), baseline DEP arterial flow was 100% versus 46.7%, residual blood flow detected after endoscopic hemostasis was 35.7% versus 0%, and 30-day rebleed rates were 28.6% versus 0% (all P < .05).
Conclusions |
(1) For major SRH versus oozing or spot, the arterial blood flow detection rate by the DEP was significantly higher, indicating a higher rebleed risk. (2) Before and after endoscopic treatment, spurting (F IA) PUB had significantly higher rates of blood flow detection than oozing (F IB) PUB and a significantly higher 30-day rebleed rate. (3) The DEP is recommended as a new endoscopic guide with SRH to improve risk stratification and potentially definitive hemostasis for PUB.
Le texte complet de cet article est disponible en PDF.Abbreviations : CURE, DDRC, DEP, F, MPEC, PPI, PUB, SRH
Plan
| DISCLOSURE: D. Jensen is a consultant for Vascular Technology Incorporated and received an equipment grant for endoscopic Doppler control units to partially support this study. He was a consultant for AstraZeneca and received an investigator-initiated research grant from AstraZeneca, which partially supported a preliminary study. All other authors disclosed no financial relationships relevant to this publication. This study was partially funded by NIH CURE DDRC Grant 41301 (Human Studies Core), a VA Clinical Merit Review Grant (to Dr Jensen, PI), an Investigator Initiated Grant from AstraZeneca USA, and an equipment grant from Vascular Technology Inc (VTI). |
|
| See CME section; p. 212. |
Vol 83 - N° 1
P. 129-136 - janvier 2016 Retour au numéro
Article précédent
- Peroral endoscopic myotomy in the endoscopy unit: location, location, location
- Davinderbir Pannu, Jeffrey D. White, Peter V. Draganov
- Determining the endpoint of endoscopic therapy for upper GI bleeding: Are our eyes as good as our ears?
- Jennifer Nayor, John R. Saltzman
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?