Endoscopic treatment of high-risk bleeding ulcers: success, rebleeding and mortality.
OBJECTIVE
Endoscopic treatment of peptic ulcers with high-risk stigmata has been probed. The rates of recurrent bleeding, need for emergent surgery and death are related to Forrest Classification, Blatchford's modified risk score and the kind of endoscopic treatment used (monotherapy vs. dual). The aims of the present study were to report the success of endoscopic therapy in the reduction of the rate of initial success, recurrent bleeding, the need for surgery, and the mortality rate for patients with bleeding peptic ulcer and high-risk stigmata.


METHODS
From a retrospective view, patients seen from September 2004 to March 2007 who had peptic ulcers Forrest Ia, Ib, IIa and/or IIb were included.


RESULTS
Fifty-six patients were included (mean [SD] age 57.3 +/-16.6 years). The success rate was 91%, whilst the rest of the patients required immediate surgery. Recurrent bleeding was presented in 14 (27%) patients and eight (14.2%) required emergency surgery. The mortality rate was 3.6%. No factors were associated with the risk of failure to initial treatment, recurrent bleeding or need for surgery. The use of monotherapy by endoscopy was associated with the mortality. The variable "performed by a fellow alone" was not associated with any kind of outcome.


CONCLUSIONS
Complication rate is similar to previous reports of general hospitals, but is higher than those of referral centers. Endoscopic monotherapy is associated with a major mortality risk.
Téllez-Avila
Félix I
FI
Gastroenterology Departament, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City. felixtelleza@gmail.com
Chávez-Tapia
Norberto C
NC
Franco-Guzmán
Ada M
AM
Duarte-Rojo
Andrés
A
López-Arce
Gustavo
G
Camacho
Jesús A
JA
Ramírez-Luna
Miguel Angel
MA
D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001803:Blood Transfusion; D003131:Combined Modality Therapy; D004564:Electrocoagulation; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000706:statistics & numerical data; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D007267:Injections; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000628:therapy*; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D013525:Surgical Instruments
D000897:Anti-Ulcer Agents; D004837:Epinephrine