Predictors of Hemostatic Failure After Hemoclip Treatment for Active Peptic Ulcer Bleeding

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Predictors of Hemostatic Failure After Hemoclip Treatment for Active Peptic Ulcer Bleeding Tae Hyeon Kim, Mi Ryeong Sim, Joo Jin Yeom, Suck Chei Choi, Yong Ho Nah Active bleeding and non-bleeding visible vessel in patients with bleeding peptic ulcer is associated with a high risk of rebleeding. The aim of our study was to define risk factors associated with failure of endoscopic hemostasis and rebleeding in patients with active peptic ulcer bleeding. Method: Ninety-six patients (56 men and 40 women; 58.8 G 15 years) with active peptic ulcer bleeding (spurting, oozing, non-bleeding visible vessel) treated in Wonkwang Medical Center from January 2002 to July 2004 were retrospectively analyzed. They were classified to endoscopic hemoclip (N Z 61) and epinephrine injection plus hemoclip (N Z 35). The clinical outcomes were compared both therapeutic modalities and the factors associated with rebleeding were analyzed. Results: Initial hemostasis was achieved in 79 patients (82.2%), 5 patients needed operations (5.2%), and 4 deaths occurred (4.1%). Recurrent bleeding, the duration of hospital stay, blood transfusion requirements, complication rate, and mortality rate were not statistically different between hemoclip alone and combination group. Univariate analysis showed that rebleeding was significantly related to the presence of shock on admission (p Z 0.04), ulcer size of more than 2 cm (p Z 0.03), hemoglobin level of less than 8 g/dL (p Z 0.001) in all patients. In a multivariate analysis, hemoglobin level of less than 8 g/dL was only positive predictor (OR 6.721, 95% CI 1.617w27.931, p Z 0.009). Conclusion: This results suggest that the combination method does not provide substantial advantage over use of the hemoclip method alone in the hemostatic management of active peptic ulcers bleeding. The presence of shock, low hemoglobin on admission, and ulcer size of more than 2 cm may be useful to predict rebleeding after initial endoscopic hemostasis in patients with active peptic ulcer bleeding. Abstracts