Predictors of Endoscopic Therapy Failure in Patients with Recurrent Non-variceal Upper Gastrointestinal Bleeding that Require a Second Endoscopy

Abstract

Purpose: Rebleeding's rate in non-variceal upper gastrointestinal bleeding remains high. Therefore, the aim of this study was to identify predictors of endoscopic therapy failure in adult patients with recurrent non-variceal upper gastrointestinal bleeding treated at the Hospital Universitario de Maracaibo between January, 2006 and December, 2010 that required a second endoscopy. Methods: The sample will be divided into Group A (with rebleeding) and B (without rebleeding within 96 hours after the first endoscopy). Data will be obtained from the reports of endoscopic procedures to evaluate the endoscopic features of lesions and the applied therapy, in order to identify the differences in the frequency of predisposing factors among groups. Results: Of the 380 cases who received therapy during the first endoscopy, 271 ulcers (71.3%; p <0.0001) represented the most frequent type of injury, followed by vascular malformations and these results were consistent with the 24 cases that rebleed (6.31%) (45.8% ulcers, n=11 vs. 33.2% vascular malformation, n=8). Rebleeding lesions were located mainly in second portion of duodenum (20.8%), gastric fundus (16.6%) and posterior duodenal bulb (12.5%). Meanwhile, the rebleeding ulcers (n=11), were duodenal 54.5% vs gastric 45.4%, classifi ed as Forrest IA, IB and IIA (p<0.03), with exposed vessel length greater than 2 mm (mean 5 mm, SD ± 3mm), of which 5 had diameters greater than 1.5 cms and rebleed despite receiving combination therapy. Conclusion: We conclude that the predictors of endoscopic therapy failure in our location are similar to those established in the literature, which correspond to the ulcer size ≥2 cms, location (posterior duodenal bulb), endoscopic signs of bleeding (Forrest IA, IB and IIA) and endoscopic therapy applied during the first episode. These factors and their severity, contribute independently to increased risk of rebleeding despite applying the recommended therapeutic.