Clin Endosc.  2011 Dec;44(2):93-100. 10.5946/ce.2011.44.2.93.

Clinical Outcomes and Risk Factors of Rebleeding Following Endoscopic Therapy for Nonvariceal Upper Gastrointestinal Hemorrhage

Affiliations
  • 1Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
  • 2Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. hyskim@yonsei.ac.kr
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Emergency Medical Technology, Daewon University College, Jecheon, Korea.

Abstract

BACKGROUND/AIMS
Rebleeding after endoscopic therapy for non-variceal upper gastrointestinal hemorrhage (NGIH) is the most important predictive factor of mortality. We evaluated the risk factors of rebleeding in patients undergoing endoscopic therapy for the NGIH.
METHODS
Between January 2003 and January 2007, 554 bleeding events in 487 patients who underwent endoscopic therapy for NGIH were retrospectively enrolled. We reviewed the clinicoendoscopical characteristics of patients with rebleeding and compared them with those of patients without rebleeding.
RESULTS
The incidence of rebleeding was 21.7% (n=120). In the multivariate analysis, initial hemoglobin level < or =9 g/dL (p=0.002; odds ratio [OR], 2.433), inexperienced endoscopist with less than 2 years of experience in therapeutic endoscopy (p=0.001; OR, 2.418), the need for more 15 cc of epinephrine (p=0.001; OR, 2.570), injection therapy compared to thermal and injection therapy (p=0.001; OR, 2.840), and comorbidity with chronic renal disease (p=0.004; OR, 2.908) or liver cirrhosis (p=0.010; OR, 2.870) were risk factors for rebleeding following endoscopic therapy.
CONCLUSIONS
Together with patients with low hemoglobin level at presentation, chronic renal disease, liver cirrhosis, the need for more 15 cc of epinephrine, or therapy done by inexperienced endoscopist were risk factors for the development of rebleeding.

Keyword

Gastrointestinal hemorrhage; Risk factors; Endoscopy; Therapy

MeSH Terms

Comorbidity
Endoscopy
Epinephrine
Gastrointestinal Hemorrhage
Hemoglobins
Hemorrhage
Humans
Incidence
Liver Cirrhosis
Multivariate Analysis
Odds Ratio
Renal Insufficiency, Chronic
Retrospective Studies
Risk Factors
Epinephrine
Hemoglobins

Figure

  • Fig. 1 Bleeding status. (A) Active pumping. (B) Active oozing. (C) Vessel exposure. (D) Red or black clot.

  • Fig. 2 Serial endoscopic findings show rebleeding after the initial endoscopic therapy. (A) Initial endoscopic finding. (B) Post state of epinephrine injection+argon plasma coagulation. (C) Rebleeding occurred 2 days after the initial endoscopic treatment. (D) Second endoscopic therapy with epinephrine injection+argon plasma coagulation. (E) Post state of second endoscopic therapy.


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