THREE’S A CROWD? A SINGLE CENTRE RETROSPECTIVE REVIEW OF ENDOSCOPIC INTERVENTION FOR UPPER GASTROINTESTINAL PEPTIC ULCER DISEASE

Aims Bleeding upper GI ulcers is a common indication for endoscopy. Its management is focused on resuscitation, pharmacological therapy and endoscopic management. ESGE does not recommend the use of adrenaline injection as monotherapy for bleeding ulcers due to the risk of rebleeding. We aimed to review departmental experience of stable non-variceal upper GI, assessing the indication and number of endoscopic interventions for bleeding upper GI ulcers.

Methods A retrospective audit of OGD records for patients at a single tertiary referral endoscopy unit with clinical suspicion of stable upper GI bleeds (UGIB) from January 2018 to July 2019 was conducted. Endoraad reports were reviewed, noting pathology encountered, intervention (adrenaline injection, clip application, Gold probe or haemospray), Forrest classification (FC) of bleeding ulcers and rebleeding, defined as post-endoscopy referral for interventional radiology or unplanned repeat endoscopy. Descriptive statistics are presented with statistical analysis performed using 2-way ANOVA.

Results From January to December 2018 533 OGDs were undertaken for suspected acute UGIB. While all included ulcers were FC I or II, this was documented in 82.22% (n=37). Forty-five patients received endoscopic intervention for bleeding ulcers. Of this cohort, 6.67%(n=3) were treated using 4 haemostatic interventional modalities, 24.44%(n=11) 3 modalities, 53.33%(n=24) 2 modalities and 15.56%(n=7) had monotherapy of whom 8.89%(n=4) received adrenaline monotherapy.

15.56%(n=7) receiving 3 or more therapies, 11.11%(n=5) receiving dual therapy and 8.89%(n=4) treated with monotherapy had repeated ulcer bleeding

Conclusions This review demonstrates the heterogenous approach adopted for management of stable upper GI ulcer bleeds, with the majority of patients treated with over 2 modalities as per ESGE guidelines. There was no noted benefit to use of more than 2 modalities although study power limits data interpretation, and use of 3 or more interventions may reflect management of higher risk bleeding ulcers in whom there is a great concern for potential to rebleed.