Predictive factors for intractability to endoscopic hemostasis in the treatment of bleeding gastroduodenal peptic ulcers in Japanese patients.
OBJECTIVE
Despite improvements in endoscopic hemostasis and pharmacological therapies, upper gastrointestinal (UGI) ulcers repeatedly bleed in 10% to 20% of patients, and those without early endoscopic reintervention or definitive surgery might be at a high risk for mortality. This study aimed to identify the risk factors for intractability to initial endoscopic hemostasis.


METHODS
We analyzed intractability among 428 patients who underwent emergency endoscopy for bleeding UGI ulcers within 24 hours of arrival at the hospital.


RESULTS
Durable hemostasis was achieved in 354 patients by using initial endoscopic procedures. Sixty-nine patients with Forrest types Ia, Ib, IIa, and IIb at the second-look endoscopy were considered intractable to the initial endoscopic hemostasis. Multivariate analysis indicated that age ≥70 years (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.07 to 4.03), shock on admission (OR, 5.26; 95% CI, 2.43 to 11.6), hemoglobin <8.0 mg/dL (OR, 2.80; 95% CI, 1.39 to 5.91), serum albumin <3.3 g/dL (OR, 2.23; 95% CI, 1.07 to 4.89), exposed vessels with a diameter of ≥2 mm on the bottom of ulcers (OR, 4.38; 95% CI, 1.25 to 7.01), and Forrest type Ia and Ib (OR, 2.21; 95% CI, 1.33 to 3.00) predicted intractable endoscopic hemostasis.


CONCLUSIONS
Various factors contribute to intractable endoscopic hemostasis. Careful observation after endoscopic hemostasis is important for patients at a high risk for incomplete hemostasis.
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Naotaka
N
Ogasawara
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Mari
M
Mizuno
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Ryuta
R
Masui
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Yoshihiro
Y
Kondo
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Yoshiharu
Y
Yamaguchi
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Kenichiro
K
Yanamoto
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Hisatsugu
H
Noda
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Noriko
N
Okaniwa
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Makoto
M
Sasaki
Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
Kunio
K
Kasugai
Aged; Cerebro-cardiovascular diseases; Forrest type; Hematemesis; Melena; Shock