title: Exposed blood vessels of more than 2 mm in diameter are a risk factor for rebleeding after endoscopic clipping hemostasis for hemorrhagic gastroduodenal ulcer.
abstract: OBJECTIVE
  There are few clinical studies on the risk factors for rebleeding based on the endoscopic hemostatic procedure carried out, including ulcer characteristics such as exposed blood vessels. The present study aims to clarify the risk factors for rebleeding after endoscopic clipping hemostasis for hemorrhagic gastroduodenal ulcers.
  
  
  METHODS
  A retrospective study was carried out with data collected during the 10-year period from January 2000 to December 2009 for 312 consecutive patients with hemorrhagic gastroduodenal ulcer. Two hundred and ninety-three patients (216 men and 77 women; mean age, 67.0 ± 15.0 years) who underwent endoscopic clipping as the initial hemostatic treatment were analyzed. The risk factors for rebleeding were determined by comparing 271 patients who did not rebleed after initial treatment with 22 patients who developed rebleeding.
  
  
  RESULTS
  The success rate of initial clipping hemostasis was 100%; however, rebleeding occurred in 7.5% (22/293) and a multivariate analysis identified exposed blood vessels of more than 2 mm in diameter as independent risk factors for rebleeding (P = 0.0124, odds ratio 6.25 [95% CI: 1.53-13.62]).
  
  
  CONCLUSIONS
  Endoscopic clipping monotherapy is effective for hemorrhagic gastroduodenal ulcers; however, exposed blood vessels of more than 2 mm in diameter in the initial endoscopic procedure are a risk factor for rebleeding.
authors.affiliation: Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
authors.forename: Shigenao
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Tomoki
authors.initials: T
authors.lastname: Inaba
authors.forename: Masaki
authors.initials: M
authors.lastname: Wato
authors.forename: Shiho
authors.initials: S
authors.lastname: Takashima
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mizushige
authors.forename: Kouichi
authors.initials: K
authors.lastname: Izumikawa
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Miyoshi
authors.forename: Kozo
authors.initials: K
authors.lastname: Kawai
mesh_terms: D000368:Aged; D005260:Female; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology* / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome