title: The efficacy of endoscopic therapy in bleeding peptic ulcer patients.
abstract: BACKGROUND
  Endotherapy is the primary modality for the control of bleeding from peptic ulceration.
  
  
  OBJECTIVE
  To assess the efficacy of endoscopic intervention for high-risk bleeding peptic ulcer disease and to benchmark our surgical and mortality rates.
  
  
  METHODS
  Two hundred and twenty-seven patients with peptic ulcers stratified by Rockall and Forrest scores as at high risk for re-bleeding underwent therapeutic intervention (adrenalin injection) between January 2004 and December 2009. The median age of the patients was 57 years (range 19 - 87 years); 60% were males. Results. Primary endoscopic haemostasis failed in 51/227 patients (22.5%); 18 patients (7.9%) required surgery for bleeding not controlled at initial or second endoscopy; and 29 patients (12.8%) died, 12 by day 3 and 17 by day 30. Fifteen patients, all with significant medical co-morbidity, died after successful primary endotherapy, and 4 died after surgery. Surgical patients required more blood (odds ratio (OR) 1.45, p=0.0001) than those not undergoing surgery, but had similar mortality. Rebleeding was the only predictor of death in patients who died by day 3 (OR 18.77). A high Rockall score was the only predictor of death by day 30 (OR 1.98).
  
  
  CONCLUSIONS
  The overall surgical and mortality rates were 7.9% and 12.8%, respectively. Over half the deaths resulted from medical co-morbidity, despite successful primary endotherapy. This finding is supported by the use of the Rockall score as a predictor of mortality at day 30. Improving the technical success of primary endoscopic haemostasis, currently 77.5%, has the potential to reduce rebleeding after primary endotherapy, a predictor of death at day 3 in this study.
authors.affiliation: University of Cape Town, South Africa. dion.levin@uct.ac.za
authors.forename: Dion A
authors.initials: DA
authors.lastname: Levin
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Watermeyer
authors.forename: Eduan
authors.initials: E
authors.lastname: Deetleefs
authors.forename: David C
authors.initials: DC
authors.lastname: Metz
authors.forename: Sandie R
authors.initials: SR
authors.lastname: Thomson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult