title: Doppler endoscopic probe as a guide to risk stratification and definitive hemostasis of peptic ulcer bleeding.
abstract: OBJECTIVE
  For more than 4 decades endoscopists have relied on ulcer stigmata for risk stratification and as a guide to hemostasis. None used arterial blood flow underneath stigmata to predict outcomes. For patients with severe peptic ulcer bleeding (PUB), we used a Doppler endoscopic probe (DEP) for (1) detection of blood flow underlying stigmata of recent hemorrhage (SRH), (2) quantitating rates of residual arterial blood flow under SRH after visually directed standard endoscopic treatment, and (3) comparing risks of rebleeding and actual 30-day rebleed rates for spurting arterial bleeding (Forrest [F] IA) and oozing bleeding (F IB).
  
  
  METHODS
  Prospective cohort study of 163 consecutive patients with severe PUB and different SRH.
  
  
  RESULTS
  All blood flow detected by the DEP was arterial. Detection rates were 87.4% in major SRH-spurting arterial bleeding (F IA), non-bleeding visible vessel (F IIA), clot (F IIB)-and were significantly lower at 42.3% (P < .0001) for an intermediate group of oozing bleeding (F IB) or flat spot (F IIC). For spurting bleeding (F IA) versus oozing (F IB), baseline DEP arterial flow was 100% versus 46.7%, residual blood flow detected after endoscopic hemostasis was 35.7% versus 0%, and 30-day rebleed rates were 28.6% versus 0% (all P < .05).
  
  
  CONCLUSIONS
  (1) For major SRH versus oozing or spot, the arterial blood flow detection rate by the DEP was significantly higher, indicating a higher rebleed risk. (2) Before and after endoscopic treatment, spurting (F IA) PUB had significantly higher rates of blood flow detection than oozing (F IB) PUB and a significantly higher 30-day rebleed rate. (3) The DEP is recommended as a new endoscopic guide with SRH to improve risk stratification and potentially definitive hemostasis for PUB.
authors: CURE Hemostasis Research Group of the CURE Digestive Diseases Research Center, Divisions of Digestive Diseases and Departments of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, Calif, USA; West Los Angeles Veterans Administration Medical Center, Los Angeles, Calif, USA.
authors: Dennis M
authors: DM
authors: Jensen
authors: CURE Hemostasis Research Group of the CURE Digestive Diseases Research Center, Divisions of Digestive Diseases and Departments of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, Calif, USA; West Los Angeles Veterans Administration Medical Center, Los Angeles, Calif, USA.
authors: Gordon V
authors: GV
authors: Ohning
authors: CURE Hemostasis Research Group of the CURE Digestive Diseases Research Center, Divisions of Digestive Diseases and Departments of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, Calif, USA; West Los Angeles Veterans Administration Medical Center, Los Angeles, Calif, USA.
authors: Thomas O G
authors: TO
authors: Kovacs
authors: CURE Hemostasis Research Group of the CURE Digestive Diseases Research Center, Divisions of Digestive Diseases and Departments of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, Calif, USA.
authors: Kevin A
authors: KA
authors: Ghassemi
authors: CURE Hemostasis Research Group of the CURE Digestive Diseases Research Center, Divisions of Digestive Diseases and Departments of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, Calif, USA.
authors: Rome
authors: R
authors: Jutabha
authors: CURE Hemostasis Research Group of the CURE Digestive Diseases Research Center, Divisions of Digestive Diseases and Departments of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, Calif, USA; West Los Angeles Veterans Administration Medical Center, Los Angeles, Calif, USA.
authors: Gareth S
authors: GS
authors: Dulai
authors: CURE Hemostasis Research Group of the CURE Digestive Diseases Research Center, Divisions of Digestive Diseases and Departments of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, Calif, USA; West Los Angeles Veterans Administration Medical Center, Los Angeles, Calif, USA.
authors: Gustavo A
authors: GA
authors: Machicado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004381:Duodenal Ulcer / Q000175:diagnosis* / Q000601:surgery; D004386:Duodenum / Q000098:blood supply*; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D013270:Stomach / Q000098:blood supply*; D013276:Stomach Ulcer / Q000175:diagnosis* / Q000601:surgery