WHEN TO DISCHARGE PATIENTS WITH BLEEDING PEPTIC-ULCERS - A PROSPECTIVE-STUDY OF RESIDUAL RISK OF REBLEEDING

Background: From January 1993 to December 1994, we conducted a prospec tive study to investigate the evolutionary change of rebleeding risk i n bleeding peptic ulcers, To obviate possible confounding factors that would influence decision making for discharge of patients, subjects w ith coexistent acute illnesses, systemic bleeding disorders, alcoholis m, and use of nonsteroidal anti-inflammatory drugs were excluded. Meth ods: Emergency endoscopies were performed in patients with hematemesis or a melena within 24 hours of admission. Ulcer lesions were divided into six categories according to endoscopic findings, The residual ris ks of rebleeding of each type of ulcers were calculated for 10 days, a nd the critical point of acceptable rebleeding risk after discharge wa s set at 3%. Results: Three hundred ninety-two patients with bleeding peptic ulcers completed the study. The ulcers, characterized by clean bases, red or black spots, adherent clots, nonbleeding visible vessels without local therapy, nonbleeding visible vessels with local therapy , and bleeding visible vessels with local therapy took 0, 3, 3, 4, 4, and 3 days, respectively, to decrease rebleeding risk to below the cri tical paint. All episodes of fatal rebleeding (n = 4) occurred within 24 hours after admission. Conclusions: Patients with clean-based ulcer s can be discharged in the first day of admission. The optimal duratio n required for hospitalization of patients with ulcers characterized b y nonbleeding visible vessels at initial endoscopy is 4 days, The rema ining patients with ulcers marked by other bleeding stigmata may be di scharged after a 3-day observation.