FACTORS PREDICTING FAILURE OF ENDOSCOPIC INJECTION THERAPY IN BLEEDING DUODENAL-ULCER

Background: The aim of this study was to assess the factors that may c ause failure of endoscopic injection in patients bleeding from a duode nal ulcer. Methods: One hundred twenty patients admitted for a bleedin g duodenal ulcer with active arterial hemorrhage or a nonbleeding visi ble vessel were included. Results: Endoscopic injection was not feasib le in 14 of 120 (11.6%) patients because of inaccessibility or massive hemorrhage. The remaining 106 patients underwent endoscopic therapy b y injection of adrenaline and polidocanol. The efficacy (achievement o f definitive hemostasis) of endoscopy therapy was 83% (88 of 106). Uni variate analysis showed that failure of endoscopic injection was relat ed to age, presence of shock, ulcer size greater than 2 cm, and hemogl obin level. Multivariate analysis showed that ulcer size greater than 2 cm (p = 0.005) and the presence of shock (p = 0.03) were factors pre dictive of endoscopic treatment failure. Failure to achieve hemostasis (p < 0.001) and poor physical status measured by American Society of Anesthesiology classification (p = 0.02) were significantly related to mortality. Conclusions: Ulcer size and severity of hemorrhage ave pre dictive of endoscopic injection failure in patients bleeding from high -risk duodenal ulcers. Survival is determined by clinical status and a ssociated diseases.