Doppler Endoscopic Probe Monitoring of Blood Flow Improves Risk Stratification and Outcomes of Patients With Severe Nonvariceal Upper Gastrointestinal Hemorrhage.
For 4 decades, stigmata of recent hemorrhage in patients with nonvariceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata rarely is monitored, but can be used to determine risk for rebleeding. We performed a randomized controlled trial to determine whether Doppler endoscopic probe monitoring of blood flow improves risk stratification and outcomes in patients with severe nonvariceal upper gastrointestinal hemorrhage.



In a single-blind study performed at 2 referral centers we assigned 148 patients with severe nonvariceal upper gastrointestinal bleeding (125 with ulcers, 19 with Dieulafoy's lesions, and 4 with Mallory Weiss tears) to groups that underwent standard, visually guided endoscopic hemostasis (control, n = 76), or endoscopic hemostasis assisted by Doppler monitoring of blood flow under the stigmata (n = 72). The primary outcome was the rate of rebleeding after 30 days; secondary outcomes were complications, death, and need for transfusions, surgery, or angiography.



There was a significant difference in the rates of lesion rebleeding within 30 days of endoscopic hemostasis in the control group (26.3%) vs the Doppler group (11.1%) (P = .0214). The odds ratio for rebleeding with Doppler monitoring was 0.35 (95% confidence interval, 0.143-0.8565) and the number needed to treat was 7.



In a randomized controlled trial of patients with severe upper gastrointestinal hemorrhage from ulcers or other lesions, Doppler probe guided endoscopic hemostasis significantly reduced 30-day rates of rebleeding compared with standard, visually guided hemostasis. Guidelines for nonvariceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F).
Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California. Electronic address: djensen@mednet.ucla.edu.
Dennis M
DM
Jensen
Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California.
Thomas O G
TOG
Kovacs
Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California.
Gordon V
GV
Ohning
Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Kevin
K
Ghassemi
Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California.
Gustavo A
GA
Machicado
Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California.
Gareth S
GS
Dulai
Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California.
Alireza
A
Sedarat
Center for Ulcer Research and Education Digestive Diseases Research Center, Gastrointestinal Hemostasis Unit, Los Angeles, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Rome
R
Jutabha
Department of Biomathematics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Jeffrey
J
Gornbein
D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D005260:Female; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D012008:Recurrence; D012039:Regional Blood Flow; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D054079:Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*
Clinical Trial; Endoscopy; Stigmata of Hemorrhage; UGI Bleeding