ULCER WITH ADHERENT CLOT: TAKE OFF OR RESPECT?

Aims For the adherent clot ulcers (IIb), the endoscopist has the choice between the detachment or the resepect of the clot .The aim of this work is to compare the two therapeutic attitudes while insisting on the recurrence and mortality.

Methods A retrospective study conducted between January 2001 and May 2019. including the 138 cases of gastrointestinal bleeding secondary to a peptic ulcer with adherent clot, who were divided to 2 groups: The first group (n=59), in whom the clot was taken off, and the second group (n=79) in whom the clot was respected.

Results Nineteen patients (13.8%) were admitted with a hemorrhagic shock .In the first group, 36 patients (26%) received endoscopic treatment while 23 were undergone surgery given the difficulty of endoscopic treatment. Among these patients, three patients (5%) recidivated: a patient has received a second endoscopic treatment, one died from an hemorrhagic shock and the third was operated and died postoperatively.

In the 2nd group, hemorrhagic recurrence was observed in 15 cases (19%): 3 patients died from haemorrhagic shock, 3 patients have undergone endoscopic treatment, 5 patients were operated while endoscopy were redone in the remaining 4 patients did not show stigmata of bleeding (3 cases of stage IIc ulcer and a case of stage III ulcer). Within this group, there were 7 deaths (8.8%) in total: 2 patients died postoperatively, 2 cases of recurrence after endoscopic treatment performed *Among the clinical, biological and endoscopic variables studied, an ulcer size exceeding 2 cm (p = 0.013) and the respect of the adherent clot (p = 0.019) are the 2factors associated with the occurrence of haemorrhagic recurrence.

Conclusions Our study shows that endoscopic treatment is more effective and has a better prognosis than just the medical treatment in the management of adherent clot ulcers especially in ulcers larger than 2cm.