A SCORING SYSTEM TO PREDICT REBLEEDING AFTER ENDOSCOPIC THERAPY OF NONVARICEAL UPPER GASTROINTESTINAL HEMORRHAGE WITH A COMPARISON OF HEAT PROBE AND ETHANOL INJECTION

We prospectively and randomly compared heat probe and ethanol injectio n in 80 patients with major nonvariceal upper gastrointestinal hemorrh age who were bleeding actively or had endoscopic stigmata associated w ith a high risk for rebleeding. We also attempted to predict which pat ients would rebleed within 72 h after successful endoscopic therapy, u sing a three-component scoring system. Heat probe and ethanol injectio n proved to be similar in efficacy and safety. Active bleeding was con trolled with equal success with heat probe and ethanol injection (92% vs. 82%), and there was no difference in the rebleeding rate (11% vs. 13%). The scoring system was useful in predicting which patients would rebleed. Significant differences were seen in the mean values of all three scores, and specific cut-offs in the pre-endoscopy and post-endo scopy scores predicted patients who rebleed. High likelihood ratios an d post-test probabilities for rebleeding were found for the number and severity of concurrent illnesses, but not for endoscopic stigmata, im plying that the excess risk associated with stigmata is eliminated aft er effective endoscopic therapy, and clinical factors become the prima ry determinants of rebleeding.