Predictors of early rebleeding after endoscopic therapy in patients with nonvariceal upper gastrointestinal bleeding secondary to high-risk lesions.
BACKGROUND
In an era of increasingly shortened admissions, data regarding predictors of early rebleeding among patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) exhibiting high-risk stigmata (HRS) having undergone endoscopic hemostasis are lacking.


OBJECTIVE
To determine predictors of early rebleeding, defined as rebleeding before completion of recommended 72 h intravenous proton pump inhibitor infusion postendoscopic hemostasis.


METHODS
Data from a national registry of patients with upper gastrointestinal bleeding (the REASON registry) were accessed. Univariable and multivariable analyses were sequentially performed to identify significant independent predictors among a comprehensive list of clinical and laboratory characteristics.


RESULTS
Overall, 393 patients underwent endoscopic hemostasis for NVUGIB with HRS. Forty patients rebled ≤72 h thereafter (32.5% female, mean [± SD] age 70.2 ± 11.8 years, 2.88 ± 2.11 comorbidities), while 21 rebled later (38.1% female, mean 70.5 ± 14.1 years of age, 2.62 ± 2.06 comorbidities). Hematemesis or bright red blood per nasogastric tube aspirate was identified as the sole independent significant predictor of early rebleeding versus later among both NVUGIB and, more specifically, patients with peptic ulcer bleeding (OR 7.94 [95% CI 1.80 to 35.01]; P<0.01, and OR 8.41 [95% CI 1.54 to 46.10]; P=0.014, respectively).


CONCLUSIONS
When attempting to determine the optimal duration of pharmacotherapy and timing of discharge for patients following endoscopic hemostasis for NVUGIB with HRS, it is noteworthy that individuals who present with hematemesis or bright red blood per nasogastric tube aspirate are at particularly high risk for rebleeding within the first 72 h.
Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
Davide
D
Maggio
Alan N
AN
Barkun
Myriam
M
Martel
Sara
S
Elouali
Ian M
IM
Gralnek
D000367:Age Factors; D000368:Aged; D001803:Blood Transfusion; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005440:Fluid Therapy; D005544:Forecasting; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000601:surgery*; D006396:Hematemesis / Q000209:etiology; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007441:Intubation, Gastrointestinal; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock / Q000209:etiology; D013396:Suction
D054328:Proton Pump Inhibitors