Which types of non-bleeding visible vessels in gastric peptic ulcers should be treated by endoscopic hemostasis?
OBJECTIVE
Because non-bleeding visible vessels (NBVV) of gastric peptic ulcers have the potential to re-bleed, endoscopic hemostatic treatment may be necessary during the first emergency endoscopy. However, not all NBVV re-bleed, and endoscopic hemostasis sometimes causes fatal side-effects. Therefore, we have evaluated the risk of re-bleeding from various NBVV in gastric peptic ulcers to determine which types should be treated by endoscopy to prevent re-bleeding.


METHODS
A total of 227 NBVV in 202 patients with gastric peptic ulcers that were endoscopically followed without endoscopic hemostatic procedures were classified by the following factors: vessel color, form, location of the NBVV in the ulcer crater, and location of the ulcer in the stomach. The re-bleeding rate was then analyzed for each type of NBVV.


RESULTS
Significantly high rates of re-bleeding were observed in cases with white, protruded and peripheral NBVV. In particular, white NBVV located in the peripheral zone of the ulcer crater were frequent re-bleeding sources. The location of the ulcer in the stomach was not a statistically significant factor in determining re-bleeding rates.


CONCLUSIONS
We found that white, protruded and peripherally located NBVV in gastric ulcers have a higher chance of re-bleeding if preventive endoscopic hemostatic procedures are not performed.
Amano
Y
Y
Departments of Gastrointestinal Endoscopy, Shimane Medical University, Shimane, Japan. amano@shimane-med.ac.jp
Moriyama
N
N
Suetsugu
H
H
Ishimura
N
N
Imaoka
T
T
Komazawa
Y
Y
Fujishiro
H
H
Ishihara
S
S
Adachi
K
K
Kinoshita
Y
Y
D016009:Chi-Square Distribution; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control*; D012008:Recurrence; D016896:Treatment Outcome