Peptic Ulcer Bleeding Research Articles

Comparison of a Polysaccharide Hemostatic Powder and Conventional Therapy for Peptic Ulcer Bleeding

Hemostatic powders have been clinically used in the treatment of gastrointestinal bleeding. We investigated the non-inferiority of a polysaccharide hemostatic powder (PHP), compared with conventional endoscopic treatments, for peptic ulcer bleeding (PUB). This study was a prospective multicenter randomized open-label controlled trial at four referral institutions. We consecutively enrolled patients who had undergone emergency endoscopy for PUB. The patients were randomly assigned to either a PHP or conventional treatment group. In the PHP group, diluted epinephrine was injected, and the powder was applied as a spray. Conventional endoscopic treatment included the use of electrical coagulation or hemoclipping after injection of diluted epinephrine. Between July 2017 and May 2021, 216 patients were enrolled in this study (PHP group, 105; control group, 111). Initial hemostasis was achieved in 92 of 105 patients (87.6%) in the PHP group and 96 of 111 patients (86.5%) in the conventional treatment group. Re-bleeding did not differ between the two groups. In subgroup analysis, the initial hemostasis failure rate in the conventional treatment group was 13.6% for Forrest IIa cases; however, there was no initial hemostasis failure in the PHP group (P=0.023). Large ulcer size (≥15mm) and chronic kidney disease with dialysis were independent risk factors for re-bleeding at 30 days. No adverse events were associated with PHP use. PHP is not inferior to conventional treatments and could be of use in initial endoscopic treatment for PUB. Further studies are needed to confirm the re-bleeding rate of PHP (ClinicalTrials.gov 02717416).

Peptic ulcer in nephrotic syndrome patients due to steroid therapy

Peptic ulcers comprise gastric and duodenal ulcers. Complications of peptic ulcers include bleeding, perforation, and obstruction. Bleeding is a major problem of peptic ulcers, as it is at times fatal. Peptic ulcer bleeding is diagnosed and treated by upper gastrointestinal (GI) endoscopy. Oral glucocorticosteroids (referred to hereafter as corticosteroids) are commonly prescribed for symptom control in patients receiving palliative care. A recent study has shown that one-third of patients admitted to an inpatient hospice unit were receiving corticosteroids. This frequency in prescribing exposes a large number of patients to the potential side effects known to be associated with corticosteroids, including weight gain, impaired glucose tolerance, and proximal myopathy.H. pylori infection is a risk factor for PUD in aspirin and NSAID users.

Peptic Ulcer Disease and Its Implications

Peptic ulcer disease (PUD) is one of the commonest diseases seen throughout the world. Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain. There are various risk factors for the development of peptic ulcer disease, but the most important ones are Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs). Patients generally present with dyspepsia or peptic ulcer bleeding. Acid suppressant therapy, H. pylori eradication, and avoidance of nonsteroidal anti-inflammatory drugs are the cornerstones of treatment of peptic ulcer disease. Peptic ulcer bleeding could be life-threatening. It is managed by appropriate supportive care, intravenous proton pump inhibitor therapy, and endoscopic homeostasis. Trans arterial embolization (TAE), Herbal treated and surgery are rarely required if endoscopic therapy fails.

A Comparative Analysis of Bleeding Peptic Ulcers in Hospitalizations With and Without End-Stage Renal Disease.

End-stage renal disease (ESRD) patients are highly susceptible to peptic ulcer bleeding (PUB). We aimed to assess the influence of ESRD status on PUB hospitalizations in the United States (USA). We analyzed the National Inpatient Sample to identify all adult PUB hospitalizations in the USA from 2007 to 2014, which were divided into two subgroups based on the presence or absence of ESRD. Hospitalization characteristics and clinical outcomes were compared. Furthermore, predictors of inpatient mortality for PUB hospitalizations with ESRD were identified. Between 2007 and 2014, there were 351,965 PUB hospitalizations with ESRD compared to 2,037,037 non-ESRD PUB hospitalizations. PUB ESRD hospitalizations had a higher mean age (71.6 vs. 63.6 years, P < 0.001), and proportion of ethnic minorities i.e., Blacks, Hispanics, and Asians compared to the non-ESRD cohort. We also noted higher all-cause inpatient mortality (5.4% vs. 2.6%, P < 0.001), rates of esophagogastroduodenoscopy (EGD) (20.7% vs. 19.1%, P < 0.001), and mean length of stay (LOS) (8.2 vs. 6 days, P < 0.001) for PUB ESRD hospitalizations compared to the non-ESRD cohort. After multivariate logistic regression analysis, Whites with ESRD had higher odds of mortality from PUB compared to Blacks. Furthermore, the odds of inpatient mortality from PUB decreased by 0.6% for every 1-year increase in age for hospitalizations with ESRD. Compared to the 2011 - 2014 study period, the 2007 - 2010 period had 43.7% higher odds (odds ratio (OR): 0.696, 95% confidence interval (CI): 0.645 - 0.751) of inpatient mortality for PUB hospitalizations with ESRD. PUB hospitalizations with ESRD had higher inpatient mortality, EGD utilization, and mean LOS compared to non-ESRD PUB hospitalizations.

Clinical outcomes of marginal ulcer bleeding compared with those of peptic ulcer bleeding.

Marginal ulcer bleeding (MUB) is a complication that can occur following several types of surgery. However, few studies exist on it. Therefore, this study aimed to compare the clinical outcomes of MUB with those of peptic ulcer bleeding (PUB). Between January 2013 and December 2017, 5,076 patients underwent emergent esophagogastroduodenoscopy for suspected upper gastrointestinal bleeding. We retrospectively reviewed and analyzed the medical records of MUB and PUB patients and developed a propensity score matching (PSM) method to adjust for between-group differences in baseline characteristics with 1:2 ratios. Sex, age, body mass index (BMI), underlying diseases, and drugs were included as matching factors. A total of 64 and 678 patients were diagnosed with MUB and PUB, respectively, on emergent esophagogastroduodenoscopy, and 62 and 124 patients with MUB and PUB, respectively, were selected after PSM. Rebleeding was significantly higher in patients with MUB than in those with PUB (57.8% vs 9.1%, p < 0.001). Mortality caused by bleeding was higher in patients with MUB than in those with PUB (4.7% vs. 0.4%, p < 0.001). Multivariate analysis revealed that proton pump inhibitor (PPI) administration (odds ratio [OR], 0.14; 95% confidence interval [CI], 0.03-0.56; p = 0.011) after first bleeding was inversely correlated with MUB rebleeding. Large ulcer size (> 1cm) (OR, 6.69; 95% CI, 1.95-27.94; p = 0.005) and surgery covering pancreas (OR, 3.97; 95% CI, 1.19-15.04) were independent risk factors for MUB rebleeding. MUB showed a severe clinical course than PUB. Therefore, MUB should be managed more cautiously, especially for large ulcers and pancreatic surgery. Prophylactic PPI administration may be helpful in reducing rebleeding in MUB.

OUTCOMES OF PEPTIC ULCER DISEASE IN PATIENTS WITH CROHN’S DISEASE: A FOUR YEAR NATIONWIDE ANALYSIS

Abstract INTRODUCTION Crohn’s disease (CD) has been known to cause transmural inflammation of the gastrointestinal wall with manifestations including ulcers, abscesses, and fistula. Peptic ulcer disease (PUD) is most commonly caused by Non-Steroid Anti-Inflammatory Drugs (NSAIDs) use &amp;/or Helicobacter pylori infection. Possible complications of PUD include perforation, bleeding, and cancer. There is no established relationship between the presence of CD and the outcomes of PUD. Therefore, we aimed to investigate the outcomes of PUD in patients with CD. METHODS This is a retrospective longitudinal study of patients admitted with a primary diagnosis of CD in the United states (US) from 2016 to 2019, using data from the nationwide inpatient sample (nis) database. A T-Test and Chi-Square were performed to compare baseline characteristics of patients with a primary diagnosis of pud, with and without a secondary diagnosis of CD (table 1). A multivariate logistic regression analysis was applied to estimate the primary outcomes of mortality, length of hospital stay (LOS) and total hospital charges (THC), and morbidity (ibd complications) adjusted for patient and hospital confounders. We used STATA® Version 17.0 Software (STATACORP, Texas, USA) for data analysis. The p-value was set at p &amp;lt; 0.05 for statistical significance. RESULTS A total of 582,710 adult patients with a primary diagnosis of PUD were identified; among them, 0.9% (n= 3415) had a secondary diagnosis of CD. Baseline characteristics are detailed IN TABLE 1. When compared to patients without cd, patients with CD were younger (mean age: 61 years), with more females (54.5% vs 48.8%, p=0.0000) and whites (79% vs 70.9%, p=0.000), and a lower prevalence of alcohol use (4.9% vs 10.9%, p=0.000). A statistically significant increase in LOS by 1.33 days (p = 0.000), and THC by 19,273 US Dollars (p = 0.010) was seen in patients with CD. Having CD was associated with no change in mortality (OR = 0.58, P = 0.206), or PUD complications, including anemia (OR = 1.07, P = 0.407), peptic ulcer bleeding (OR = 1.15, P = 0.490), perforation (OR = 1.76, P = 0.115), hypovolemic shock (OR = 1.00, P = 0.115), septic shock (OR = 1.15, P = 0.667), and blood transfusions (OR = 0.92, P = 0.411) (Figure 1). No case of gastric malignancy was identified in our study population. DISCUSSION The presence of CD does not carry a significant impact on PUD outcomes in terms of mortality and acute PUD complications. However, hospital utilization appears to be higher in patients with CD. In order to identify a possible relationship between CD and gastric malignancy, studies over longer periods would be necessary .

Predictors of Rebleeding in Non-variceal Upper Gastrointestinal Bleeding of Peptic Ulcer Etiology in Kashmiri Population.

Background Upper gastrointestinal bleeding (UGIB) represents a substantial clinical and economic burden and rebleeding is one of the most important predictors of morbidity and mortality. Identifying patients who are likely to rebleed is a critical component of effectively managing patients with bleeding peptic ulcers. So, the study was undertaken to look for predictors of rebleeding in patients with bleeding peptic ulcers and try to find out the new scoring system to predict rebleeding in our population. Material and methods A retrospective analysis of prospectively maintained hospital data of UGIB patients was done and 480 patients of endoscopically documented peptic ulcers whose complete data was available were taken for study. Results Among the studied patients, men constituted 84.6%, and most of the patients were in the third to sixth decade of life with a mean age of 40.9±15.9 years, 76% were from rural areas. Only males with a mean age of 38.4±19.8 rebled with a rebleeding rate of 2.9% only. Half of the patients who rebled were in shock at the time of presentation. Those who rebled received more units of blood transfusion (mean 3±1.8),had a large mean ulcer sizeof Forest class IIa and IIb and epinephrine injection monotherapy group with varied statistical significance. Among rebleeders (n=14), eight patients were managed by a second endoscopic therapy, and six (42.8%) rebleeders and 1.25% of patients in total needed surgery. Two patients ultimately died giving overall mortality of 0.4% and mortality of 14.3% among rebleeders. Conclusion Our study found a very low rebleeding rate and mortality which could be explained by a young population with fewer co-morbidities and better response to proton pump inhibitor therapy. The significant parameters related to rebleeding were shockat presentation, degree of smoking, units of blood transfused, ulcer size, and high-risk endoscopic stigmata.

Oral versus intravenous omeprazole in management of bleeding peptic ulcer: a randomized controlled trial

Background Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency with significant morbidity and mortality. Intravenous (IV) route administration of proton pump inhibitors is more commonly used for prevention of bleeding; however, it is more expensive and invasive than the oral route. We, herein, compared between oral and IV omeprazole in patients with high-risk UGIB regarding outcome. Patients and methods Patients with high risk for rebleeding peptic ulcers were included. All patients initially received IV omeprazole, and then esophagogastroduodenoscopy with hemostatic procedure was done. Thereafter, the patients were allocated to group A, who received oral omeprazole, and group B, who received IV omeprazole. The patients were followed up for 2 weeks for signs of rebleeding. Reendoscopy, angioembolization, or surgery was provided when needed (NCT04170270). Results The study included 189 patients (96 in group A and 93 in group B). Frequency of rebleeding was higher among patients in group B (40%) compared with those in group A (30%) (P: 0.1). Reendoscopy was more frequently required for patients in group B (16.1%) than those in group A (3.1%) (P&lt;0.001). Surgery was mandatory for three (3.2%) patients in group B, whereas angioembolization was used nearly equally in both groups (31.3% in group A vs. 29% in group B). Admission to ICU was more frequently needed (P: 0.02) and the length of hospital stays was longer (P: 0.003) for patients of group B. Regarding UGIB-related deaths, three (3.1%) patients from each group died. Conclusion Oral omeprazole is not inferior to IV omeprazole as adjuvant therapy to control peptic ulcer bleeding and to reduce the frequency of rebleeding.

ABC score is an effective predictor of outcomes in peptic ulcer bleeding.

Risk stratification is recommended for patients with gastrointestinal (GI) bleeding. The ABC score is a new scoring tool with high accuracy for upper and lower GI bleeding. We aimed to evaluate the effectiveness of the ABC score in predicting the outcomes of patients with peptic ulcer bleeding. This single-center retrospective study included 809 patients, each with symptoms of upper GI bleeding, and who were diagnosed with ulcerative lesions between October 2011 and March 2021. The association between the ABC score's variables and the patients' outcome was analyzed. The score's performance in predicting the patients' outcome was validated using receiver-operating characteristic curve analysis and compared with that of other scores. The study analyzed 772 patients with peptic ulcer bleeding. The primary outcome measure was all-cause 30-day mortality. Secondary outcome measures included rebleeding within 30 days and the need for radiologic/surgical intervention. Age (P = .013), serum albumin levels (P < .001), serum creatinine levels (P = .004), mental status (P < .001), and American Society of Anesthesiologists score (P < .001) were associated with the primary outcome. The ABC score predicted the 30-day mortality (area under the receiver-operating characteristic curve [AUROC] 0.927; 95% confidence interval [CI] 0.899-0.956) better than other scores. However, it was less accurate in predicting rebleeding (AUROC 0.630; 95% CI 0.563-0.697) and need for radiologic/surgical intervention (AUROC 0.641; 95% CI 0.550-0.732). The ABC score accurately predicts the 30-day mortality in patients with peptic ulcer bleeding. However, it may not be suitable for predicting rebleeding or the need for radiologic/surgical interventions.

Impact of Helicobacter pylori Eradication on Incidence of Peptic Ulcer Bleeding in Patients Taking Regular Aspirin

Hawkey C, Avery A, Coupland CAC, et al; HEAT Trialists. Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial. Lancet 2022; 400(10363):1597–1606.

Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial

Peptic ulcers in patients receiving aspirin are associated with Helicobacter pylori infection. We aimed to investigate whether H pylori eradication would protect against aspirin-associated ulcer bleeding. We conducted a randomised, double-blind, placebo-controlled trial (Helicobacter Eradication Aspirin Trial [HEAT]) at 1208 primary care centres in the UK, using routinely collected clinical data. Eligible patients were aged 60 years or older who were receiving aspirin at a daily dose of 325 mg or less (with four or more 28-day prescriptions in the past year) and had a positive C13 urea breath test for H pylori at screening. Patients receiving ulcerogenic or gastroprotective medication were excluded. Participants were randomly assigned (1:1) to receive either a combination of oral clarithromycin 500 mg, metronidazole 400 mg, and lansoprazole 30 mg (active eradication), or oral placebo (control), twice daily for 1 week. Participants, their general practitioners and health-care providers, and the research nurses, trial team, adjudication committee, and analysis team were all masked to group allocation throughout the trial. Follow-up was by scrutiny of electronic data in primary and secondary care. The primary outcome was time to hospitalisation or death due to definite or probable peptic ulcer bleeding, and was analysed by Cox proportional hazards methods in the intention-to-treat population. This trial is registered with EudraCT, 2011-003425-96. Between Sept 14, 2012, and Nov 22, 2017, 30 166 patients had breath testing for H pylori, 5367 had a positive result, and 5352 were randomly assigned to receive active eradication (n=2677) or placebo (n=2675) and were followed up for a median of 5·0 years (IQR 3·9-6·4). Analysis of the primary outcome showed a significant departure from proportional hazards assumptions (p=0·0068), requiring analysis over separate time periods. There was a significant reduction in incidence of the primary outcome in the active eradication group in the first 2·5 years of follow-up compared with the control group (six episodes adjudicated as definite or probable peptic ulcer bleeds, rate 0·92 [95% CI 0·41-2·04] per 1000 person-years vs 17 episodes, rate 2·61 [1·62-4·19] per 1000 person-years; hazard ratio [HR] 0·35 [95% CI 0·14-0·89]; p=0·028). This advantage remained significant after adjusting for the competing risk of death (p=0·028) but was lost with longer follow-up (HR 1·31 [95% CI 0·55-3·11] in the period after the first 2·5 years; p=0·54). Reports of adverse events were actively solicited; taste disturbance was the most common event (787 patients). H pylori eradication protects against aspirin-associated peptic ulcer bleeding, but this might not be sustained in the long term. National Institute for Health and Care Research Health Technology Assessment.

Use of over-the-scope clip (OTSC) versus standard therapy for the prevention of rebleeding in large peptic ulcers (size ≥1.5 cm): an open-labelled, multicentre international randomised controlled trial

IntroductionOver-the-scope clip (OTSC) has been used recently for primary haemostasis of peptic ulcers. This study aimed to compare the efficacy of OTSC to standard endoscopic therapy in primary treatment of...

Clinical Outcomes of Patients with Benign Peptic Ulcer Bleeding After an Emergency Endoscopy Based on Patient Location.

In the efforts toward reducing bleeding-related mortality, it is crucial to determine the risk factors for rebleeding after endoscopic hemostasis in benign peptic ulcer (BPU). Between 2013 and 2017, the medical records of 864 BPU patients were selected from 5076 who had undergone emergency endoscopy for suspected upper gastrointestinal bleeding. Patients who visited the emergency room or were hospitalized for other illnesses were selected. The primary end point was rebleeding within 30days after initial endoscopy. The risk factors of rebleeding and subgroup analyses according to patient location were evaluated. Among 864 BPU bleeding patients, rebleeding after completion of BPU bleeding occurred in 140 (16.2%). Initial indicators of hypotension (OR 1.878, p = 0.005) and Forrest classes Ia (OR 25.53, p < 0.001), Ib (OR 27.91, p = 0.005), IIa (OR 21.41, p < 0.001), and IIb (OR 23.74, p < 0.001) were independent risk factors of rebleeding compared to Forrest class III, and being inpatients (OR 1.75, p = 0.01). Compared to the outpatients, the inpatients showed significantly higher rebleeding rates (25.6% vs 13.8%, p < 0.001), predictive bleeding scores, red blood transfusion counts, proportion of Forrest classes Ia, Ib, and IIb (p < 0.001), and overall mortality rates (68.8% vs 34.0%, p < 0.001). Patient location was a novel predictive factor of BPU rebleeding. Particularly, being an inpatient correlated with increased rebleeding. Furthermore, Forrest classes Ia, Ib, IIa, and IIb were predictive of rebleeding not only the included BPUs, but also in the inpatient or outpatient groups.

An extended 36-week oral esomeprazole improved long-term recurrent peptic ulcer bleeding in patients at high risk of rebleeding

BackgroundPatients with Rockall scores ≥6 have an increased risk of long-term peptic ulcer rebleeding. This study was aimed toward investigating whether an extended course of oral esomeprazole up to 1 year decreased ulcer rebleeding in such patients.MethodsWe prospectively enrolled 120 patients with peptic ulcer bleeding and Rockall scores ≥6. After an initial 16-week oral proton pump inhibitor (PPI) treatment, patients were randomized to receive a 36-week course of oral twice-daily esomeprazole 20 mg (Group D, n = 60) or once-daily (Group S, n = 60). Thereafter, they were divided into the PPI-on-demand (n = 32) and PPI-discontinued (n = 77) subgroups. Our previous cohort with Rockall scores ≥6 served as the controls (Group C, n = 135); they received only an initial 8- to 16-week oral PPI. The primary and secondary outcomes were peptic ulcer rebleeding during the first year and the second year-and-thereafter, respectively.ResultsFor the primary outcome, groups D and S comprised a higher proportion of rebleeding-free than Group C (P = 0.008 and 0.03, log-rank test). The competing-risks regression analysis confirmed that extended PPI use and American Society of Anesthesiologists classification were independent factors contributing to the primary outcome. For the secondary outcome, PPI-on-demand had a borderline higher proportion of rebleeding-free than Group C (P = 0.07, log-rank test); however, only the Rockall score was the independent factor.ConclusionsAn extended 36-week course of oral esomeprazole 20 mg, twice- or once-daily for patients with Rockall scores ≥6 reduced ulcer rebleeding during the first year, but the effect needed to be further validated when PPIs were shifted to on-demand or discontinued thereafter (NCT02456012, 28/05/2015).

Reduced mortality for over-the-scope clips (OTSC) versus surgery for refractory peptic ulcer bleeding: a retrospective study

BackgroundSurgery or transcatheter arterial embolization or are both considered as standard treatment of peptic ulcer bleeding (PUB) refractory to endoscopic hemostasis. Over-The-Scope clips (OTSC) have shown superiority to standard endoscopic treatment but a comparison with surgery has not been performed, yet.Patients and methodsIn this retrospective, multicenter study, 103 patients treated with OTSC (n = 66) or surgery (n = 37) for refractory PUB in four tertiary care centers between 2009 and 2019 were analyzed. Primary endpoint was clinical success (successful hemostasis and no rebleeding within seven days). Secondary endpoints were adverse events, length of ICU-stay and in-hospital mortality. Univariable and multivariable regression models were performed to define predictive factors for allocation to surgical therapy and for mortality.ResultsAge, comorbidities, anticoagulation therapy, number of pretreatments, ulcer location, and Rockall-Score were similar in both groups. In the surgical group, there were significantly more patients in shock at rebleeding (78.1% vs. 43.9%; p = 0.002), larger ulcers (18.6 ± 7.4 mm vs. 23.0 ± 9.4 mm; p = 0.017) and more FIa bleedings (64.9% vs. 19.7%; p < 0.001) were detected. Clinical success was comparable (74.2% vs. 83.8%; p = 0.329). In the surgical group, length of ICU-stay (16.2 ± 18.0 days vs. 4.7 ± 6.6 days; p < 0.001), severe adverse events (70.3% vs. 4.5%; p < 0.001) and in-hospital mortality (35.1% vs. 9.1%; p = 0.003) were significantly higher. Multivariable analysis defined shock at rebleeding as the main predictor for allocation to surgical therapy (OR 4.063, 95%CI {1.496–11.033}, p = 0.006). Postsurgical adverse events were the main reason for the in-hospital mortality (OR 5.167, 95% CI {1.311–20.363}, p = 0.019).ConclusionIn this retrospective study, OTSC compared to surgical treatment showed comparable clinical success but was associated with shorter ICU-stay, less severe adverse events and lower in-hospital mortality.

Endoscopic cyanoacrylate injection therapy for refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy

Objective To evaluate the efficacy and safety of endoscopic cyanoacrylate injection therapy for refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy. Methods 154 patients with refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy at the Affiliated Hospital of Zunyi Medical Univesity and the People’s Hospital of Liupanshui City from January 2018 to December 2021were enrolled in this study. Endoscopic intracellular cyanoacrylate injection was first carried out. When failure, perintravascullar injection was carried out. The data were retrospectively collected. Results Among the 154 patients, 102 patients (66.23%) obtained successful intravascular injection and perivascular injection was performed in 52 patients (33.77%). Immediate hemostatic rate for active bleeding achieved 93.18%. Overall rebleeding rate within 30 days was 12.99% and successful hemostasis rate achieved 87.01%. Immediate hemostatic rate and successful hemostasis rate in intravascular injection patients were markedly superior over perivascular injection. Rebleeding rate in intravascular injection patients was markedly lower than that in perivascular injection patients. 14 patients complicated abdominal pain and no other complication occurred. Conclusion Endoscopic cyanoacrylate injection therapy, especial intravascular injection, was effective and safe, with high successful hemostasis rate for refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy.

Outcomes of Endoscopic Therapy in Patients with Peptic Ulcer Bleeding

Outcomes of Endoscopic Therapy in Patients with Peptic Ulcer Bleeding

Use of helical tack system for management of a high-risk fibrotic peptic ulcer

GI bleeding because of peptic ulcer disease is a well-described entity in its diagnosis and management. Although hemostatic clips and thermal therapy have been the primary tools in bleeding from peptic ulcer disease, some bleeds remain refractory. New data have shown that obliteration of the underlying arterial blood flow is needed to control refractory peptic ulcer bleeding. Although this has been shown with over-the-scope clips, we present a case where GI bleeding is controlled via a helical tack system. Although there are several available tools that can be used for treatment of upper GI bleeds, there remains a need for devices that can be used when standard methods of closure, such as with clips, cannot be performed because of a challenging location or friable mucosa. The aim of this video case is to demonstrate the use of a novel helical tack system as a salvage technique in the treatment of challenging upper GI bleeds. One case of a bleeding GI ulcer that was refractory to standard endoscopic clips was identified. In this case, the ulcer closure was achieved using the helical tack system. There were no adverse events. The patient did not require additional surgical or endoscopic interventions. The helical tack system is a novel device that may be useful as a salvage method for the cessation of GI bleeds refractory to standard clips. Additional comparative studies are needed to better understand the advantages and disadvantages of this system relative to other closure tools.

S1601 Peptic Ulcer Bleeding in End-Stage Renal Disease Hospitalizations: A Comparative Analysis in the United States

S1601 Peptic Ulcer Bleeding in End-Stage Renal Disease Hospitalizations: A Comparative Analysis in the United States

S677 Overt Gastrointestinal Bleeding in Patients With Cancer: Clinical Characteristics and Outcomes

S677 Overt Gastrointestinal Bleeding in Patients With Cancer: Clinical Characteristics and Outcomes