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. 2011 Dec;44(2):93-100.
doi: 10.5946/ce.2011.44.2.93. Epub 2011 Dec 31.

Clinical outcomes and risk factors of rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage

Ki Tae Suk  1 , Hyun-Soo Kim, Chang Seob Lee, Il Young Lee, Moon Young Kim, Jae Woo Kim, Soon Koo Baik, Sang Ok Kwon, Dong Ki Lee, Young Lim Ham
Affiliations

Clinical outcomes and risk factors of rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage

Ki Tae Suk et al. Clin Endosc. 2011 Dec.

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 ≤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.

Keywords: Endoscopy; Gastrointestinal hemorrhage; Risk factors; Therapy.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Bleeding status. (A) Active pumping. (B) Active oozing. (C) Vessel exposure. (D) Red or black clot.
Fig. 2
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.
See this image and copyright information in PMC

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