Endoscopy 2020; 52(S 01): S179
DOI: 10.1055/s-0040-1704556
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PREDICTORS OF FAILURE OF ENDOSCOPIC HEMOSTASIS IN PATIENTS WITH SEVERE PEPTIC ULCER BLEEDING

A Afifi
1   Universitätsklinikum Magdeburg, Gastroenterology and Hepatology, Magdeburg, Germany
,
A Kandulski
2   Universitätsklinikum Regensburg, Gastroenterology and Hepatology, Regensburg, Germany
,
M Pech
3   Universitätsklinikum Magdeburg, Radiology, Magdeburg, Germany
,
RS Croner
4   Universitätsklinikum Magdeburg, Surgery, Magdeburg, Germany
,
J Weigt
1   Universitätsklinikum Magdeburg, Gastroenterology and Hepatology, Magdeburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims To identify predictive factors for failure of endoscopic hemostasis.

    Methods Single center retrospective analysis of patients presented with peptic ulcer bleeding between Jan 2007 and Feb 2016. Patients without re-bleeding (group A) were compared to patients with re-bleeding (group B). Furthermore a subgroup of patients that required coil embolization to achieve hemostasis was analyzed using matched pair analysis. The groups were compared regarding sex, age, ulcer size and number, predisposing factors, clinical presentation, type of endoscopic intervention and comorbidities.

    Results In total 18,816 upper endoscopies were performed. Peptic ulcer bleeding was detected in 754 patients (4%). Bleeding solitary ulcers were the commonest (64.46%). Forrest Ib ulcers were most commonly detected (182 pts.(24.14%)). The commonest predisposing factor was aspirin intake (288 pts. (38.20%)) followed by H. pylori infection (267 pts. (35.41%)), NSAIDs in 115 pts.(15.25%) and anticoagulants in 179 pts.(23.74%). H. pylori and aspirin was the most frequent combination but was found only in 93 pts.(12.33%). Epinephrine injection was used in 323 pts. (42.84%) followed by clip therapy in 260 pts.(34.48%). Re-bleeding occurred in 110 pts.(14.58%). We identified the following risk factors for re-bleeding: age between 60 and 80 years (p= 0.013), localization in the antrum (p< 0.001), size above 2 cm (p=0.040), anticoagulation therapy (p=0.017) and Forrest types Ib, Ia, IIa (p< 0.001). Hemostasis was endoscopically achieved in 391 pts.(53.05%). PPI therapy without any other intervention was used in 303 pts.(40.18%), 11 pts.(1.46%) received surgery, coil embolization was needed in 44 pts.(5.84%) and 5 pts.(0.66%) died from bleeding. The matched pair analysis regarding patients with re-bleeding that couldn’t be treated by endoscopy was not able to identify one of the above mentioned risk factors as being significant.

    Conclusions Our study confirms well known risk factors for peptic ulcer bleeding and re-bleeding. However, treatment success after re-bleeding cannot be predicted by the same factors.


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