[Comparison between Endoscopic Therapy and Medical Therapy in Peptic Ulcer Patients with Adherent Clot: A Multicenter Prospective Observational Cohort Study].
OBJECTIVE
The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk factors of rebleeding in Forrest type IIB peptic ulcer.


METHODS
Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December 2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic ulcer with adherent clots were enrolled.


RESULTS
Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs.10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group. However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641). In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1; p=0.025).


CONCLUSIONS
In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding was use of aspirin and/or NSAID.
Departments of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Si Hye
SH
Kim
Departments of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Jin Tae
JT
Jung
Departments of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Joong Goo
JG
Kwon
Departments of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Eun Young
EY
Kim
Departments of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Dong Wook
DW
Lee
Kyungpook National University School of Medicine, Daegu, Korea.
Seong Woo
SW
Jeon
Keimyung University School of Medicine, Daegu, Korea.
Kyung Sik
KS
Park
Yeungnam University College of Medicine, Daegu, Korea.
Si Hyung
SH
Lee
Dongguk University School of Medicine, Gyeongju, Korea.
Jeong Bae
JB
Park
Gyeongsang National University Hospital, Jinju, Korea.
Chang Yoon
CY
Ha
Soonchunhyang University Gumi Hospital, Gumi, Korea.
Youn Sun
YS
Park
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010437:Peptic Ulcer / Q000150:complications / Q000175:diagnosis; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors; D001241:Aspirin
Bleeding; Mortality; Peptic ulcer; Risk factors