Factors predicting incomplete endoscopic hemostasis in bleeding gastroduodenal ulcers.
OBJECTIVE
To investigate the factors contributing to failure of initial hemostasis in patients undergoing endoscopic hemostasis.


METHODS
A total of 316 patients underwent endoscopic hemostasis for bleeding peptic ulcers in a period of 4 years.


RESULTS
For hemostatic procedures, application of hemostatic clips, band ligation, injection of hypertonic saline epinephrine solution, soft coagulation, and argon plasma coagulation were employed either singly or in combination. Patients were divided into the following 2 groups for multivariate analysis: durable hemostasis (n = 268) and failed initial (incomplete) hemostasis (n = 48). Hemodialysis was a risk factor of incomplete hemostasis (Odds Ratio [OR] = 2.306, 95% confidence interval [CI] = 1.033-5.147; p = 0.041). Compared with the duodenal 2nd portion, the following bleeding sites had significantly lower risk of incomplete hemostasis (approximately 5 times less likely): The duodenal bulb (D), OR = 0.215, 95% CI = 0.058-0.797 (p = 0.022); the L region, OR = 0.207, 95% CI = 0.046-0.919 (p = 0.038); the M region, OR = 0.132, 95% CI = 0.036-0.482 (p = 0.002); and the U region, OR = 0.164, 95% CI = 0.041-0.649 (p = 0.01). CONCLUSIONn: Hemodialysis and a bleeding site located in the duodenal second portion were the factors strongly associated with incomplete hemostasis in bleeding gastroduodenal ulcers.
Urayama
Naoki
N
Department of Gastroenterology, Kokura Memorial Hospital, 1-1 kifune-machi, Kokurakita-ku, kitakyushu, Fukuoka 802-8555, Japan.
Shiraishi
Kei
K
Aoyama
Koji
K
Fujimoto
Kenji
K
Matsumoto
Toshihiko
T
Omori
Kaoru
K
Nishina
Sohji
S
Saiki
Yasuhiko
Y
Kojima
Noboru
N
Hirano
Atsuyoshi
A
Nishiaki
Makoto
M
Okita
Satoshi
S
Yutoku
Kouki
K
Kubo
Yoshitsugu
Y
Maetani
Noboru
N
Iida
Yozo
Y
Odawara
Mitsuru
M
Yoshida
Tomoharu
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects; D005260:Female; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D012307:Risk Factors
D001241:Aspirin