Endoscopic therapy for peptic ulcer hemorrhage: practice variations in a multi-center U.S. consortium.
BACKGROUND
Peptic ulcer disease is a common cause of acute upper gastrointestinal hemorrhage. The aim of this study was to describe the endoscopic management of bleeding peptic ulcers in a large, U.S. multi-center endoscopic consortium with diverse practice settings.


METHODS
Adult patients who underwent upper endoscopy (EGD) for hematemesis, melena or "suspected upper GI bleed" between January 2000 and December 2004 in the Clinical Outcomes Research Initiative (CORI) endoscopic database were screened for the finding of peptic ulcer. The ulcer stigmata, endoscopic therapy and the need for repeat EGD were compared across practice sites.


RESULTS
Of 12,392 patients who underwent EGD for an upper gastrointestinal bleeding indication, 3,692 (30%) had at least one peptic ulcer (clean base 59.9%; flat pigmented spot 13.4%; active bleeding 10.7%; clot 7.2%; non-bleeding visible vessel (NBVV) 6.3%). Endoscopic therapy was applied to 93% of actively bleeding ulcers and 95% of NBVV. Repeat endoscopy was required in 7.3% of patients. Ulcers treated with injection monotherapy had the highest repeat EGD rates (12.2%) compared with contact thermal monotherapy (6.1%) and combination thermal/injection therapy (7.1%) (P=0.02). Immediate hemostasis rates were 88-97% across all therapeutic modalities. There was no statistical difference in hemostasis rates across therapy nor practice types.


CONCLUSIONS
In this multi-center consortium, initial hemostasis rates were high across therapy types and sites studied. Injection monotherapy was associated with the highest rates of repeat EGD, supporting guidelines that advise against its use in bleeding peptic ulcers.
Enestvedt
Brintha K
BK
Division of Gastroenterology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Mail Code L-461, Portland, OR 97239, USA. enestveb@ohsu.edu
Gralnek
Ian M
IM
Mattek
Nora
N
Lieberman
David A
DA
Eisen
Glenn M
GM
D000368:Aged; D019992:Databases as Topic; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006396:Hematemesis / Q000209:etiology / Q000628:therapy; D016558:Hemostasis, Endoscopic / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008551:Melena / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010438:Peptic Ulcer Hemorrhage / Q000150:complications / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States