4704 Risk factors for early rebleeding after initial endoscopic hemostasis in patients with bleeding peptic ulcers.

Abstract

Background & Aims: Rebleeding after initial endoscopic hemostasis in patients with ulcer hemorrhage was been reported in 20-30%. Identification of patients who are at high risk for rebleeding would be expected to improve the outcome of endoscopic hemostasis. The purpose of this study was to evaluate the risk factors for early rebleeding after initial hemostasis in the view of clinical and endoscopic characteristics. Materials & Methods:We reviewed 99 patients who presented with bleeding peptic ulcers and were treated with endoscopic hemostasis including hypertonic saline injection, electrocautery and clipping. We compared the clinical variables (age, blood transfusioin, comorbid illness, initial systolic BP and pulse rate, hemoglobin), endoscopic characteristics of ulcer (size, number, and location of ulcer, clots on the base, bleeding stigmata, size and color of exposed vessle) and Baylor Bleeding Score between the patients who had early rebleeding (n=22) and who had no early rebleeding (n=77) within 5 days. All data were compared with Pearson's chisquare test in both groups, and multivariate analysis was tested with logistic regression and expressed as odds ratio in 95% confidence interval. Results: The stasistically significant correlates with early rebleeding after hemostasis were number of comorbid illness (≥2) (p=0.031), volume of transfusion (≥5 units) (p=0.001), size of ulcer (>1 cm) (p=0.024), multiple ulcers (p=0.017), presence of blood clots on ulcer base (p=0.008), stigmata (active bleeding and visible vessles) (p=0.005), size of vessle (>1 mm) (p=0.001) and pearl-colored vessle rather than black-colored (p=0.001). In multivariate analysis, volume of transfusion (5.4;1.94-14.97), ulcer size (4.53;0.98-20.94), multiple ulcers (3.17;1.16-8.17) and size of exposed vessle (16.73;5.23-53.49) were significant risk factors. There was no correlation between Baylor Bleeding Score and rebleeding in our study. Old age(>60 years), smoking, NSAIDs use, initial systolic BP, initial hemoglobin, location of ulcer and H. pylori infection were not stastistically significant factors adversely affecting rebleeding. Conclusions: The risk factors for early rebleeding after hemostasis in bleeding peptic ulcer can be predicted by clinical variables and endoscopic findings. Early evaluation of risk factors such as transfusion over 5 units, large-sized ulcer, multiple ulcers and size of exposed vessle over 1 mm in initial hemostasis can improve the outcome of hemostasis.