Endoscopy 2006; 38(7): 726-729
DOI: 10.1055/s-2006-925179
Short Communication
© Georg Thieme Verlag KG Stuttgart · New York

Predictors of peptic ulcer rebleeding after scheduled second endoscopy: clinical or endoscopic factors?

P.  W.  Y.  Chiu1 , H.  K.  M.  Joeng2 , C.  L.  Y.  Choi2 , K.  H.  Kwong2 , E.  K.  W.  Ng1 , S.  H.  Lam2
  • 1 Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
  • 2 Department of Surgery and Endoscopy Center, United Christian Hospital, Hong Kong
Further Information

Publication History

Submitted 30 June 2005

Accepted after revision 13 November 2005

Publication Date:
29 June 2006 (online)

Background and study aims: In a previous study we demonstrated the efficacy of second-look endoscopy with therapy within 16 - 24 hours after index endoscopy in reducing major recurrent peptic ulcer bleeding. In this study, we sought to identify factors that might predict further rebleeding after this scheduled second-look endoscopy.
Patients and methods: We studied 249 patients (181 men, 68 women) with acute bleeding peptic ulcers who were treated at the United Christian Hospital, Hong Kong from 1999 to 2002 and who underwent a scheduled second endoscopy. Those patients who developed rebleeding after the second endoscopy were evaluated, and possible predictive factors for rebleeding were analyzed using a logistic regression model.
Results: Of the 249 patients who underwent scheduled second-look endoscopy, 17 patients (6.8 %) developed rebleeding: seven of these patients were treated by another endoscopic therapy; ten patients required surgery. The overall mortality rate was 3.1 %. A logistic regression analysis performed on the possible predictive factors for rebleeding found that the following factors were associated with a significant risk of further rebleeding after scheduled second endoscopy: American Society of Anesthesiologists (ASA) grade III or grade IV status (odds ratio 3.81, 95 % CI 1.27 - 11.44), ulcer size greater than 1.0 cm (odds ratio 4.69, 95 % CI 1.60 - 13.80), and a finding of persistent stigmata of recent hemorrhage at the scheduled second endoscopy (odds ratio 6.65, 95 % CI 2.11 - 20.98).
Conclusions: Endoscopic factors, including large ulcer size and the persistence of endoscopic stigmata of recent hemorrhage are important predictors for recurrent bleeding after scheduled second endoscopy.

References

P. W. Y. Chiu, M. D.

Department of Surgery

Prince of Wales Hospital · The Chinese University of Hong Kong · 30-32, Ngan Shing Street · Shatin · New Territories · Hong Kong

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Email: pwychiu@netvigator.com