title: Major stigmata of recent hemorrhage on rectal ulcers in patients with severe hematochezia: Endoscopic diagnosis, treatment, and outcomes.
abstract: BACKGROUND
  Endoscopic diagnosis and treatment of hematochezia caused by rectal ulcers is poorly described.
  
  
  METHODS
  Consecutive patients hospitalized with severe hematochezia underwent urgent colonoscopy after purge. Those with rectal ulcers were divided into 2 groups based on the absence or presence of major stigmata of recent hemorrhage: active bleeding, visible vessel, or adherent clot. Major stigmata were treated with epinephrine injection and coagulation with a bipolar probe. The primary outcome endpoint was recurrent bleeding within 4 weeks of diagnosis.
  
  
  RESULTS
  Rectal ulcers were identified in 23 of 285 (8%) patients. Twelve of 23 patients had major stigmata; these patients had an arithmetically greater decrease in hematocrit and required more blood transfusions than patients without major stigmata. Initial hemostasis was achieved in all, but bleeding recurred in 5 with stigmata. Four patients died of comorbid conditions. There was no recurrent bleeding or death in those without stigmata.
  
  
  CONCLUSIONS
  Patients with rectal ulcers harboring major stigmata are at high risk for severe bleeding, recurrent bleeding, and death. For ulcers with major stigmata, endoscopic hemostasis is feasible but rates of recurrent bleeding are high.
authors.affiliation: Division of Digestive Diseases and Department of Medicine, UCLA School of Medicine, Los Angeles, California, USA.
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
authors.forename: Gareth
authors.initials: G
authors.lastname: Dulai
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Jensen
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gralnek
authors.forename: Thomas O g
authors.initials: TO
authors.lastname: Kovacs
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Machicado
authors.forename: Rome
authors.initials: R
authors.lastname: Jutabha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012002:Rectal Diseases / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome; D014456:Ulcer