THE NONBLEEDING VISIBLE VESSEL VERSUS THE SENTINEL CLOT - NATURAL-HISTORY AND RISK OF REBLEEDING

Non-bleeding visible vessel and sentinel clot are terms used interchan geably to describe protuberances in the base of ulcers that have recen tly bled, but a consensus as to their definition or natural history do es not exist. In patients with severe ulcer hemorrhage, non-bleeding p rotuberances were classified as vessels, with or without a small attac hed clot, or as sentinel clots, according to a schema based on the app earance of the protuberance at endoscopy but not subjected to patholog ic correlation. Endoscopic therapy was not performed at the index endo scopic evaluation, and natural evolution was prospectively documented with daily videoendoscopy. Eleven (46%) of 24 patients with non-bleedi ng protuberances had rebleeding. Independent classification by three a uthors concurred in 18 (75%) of 24 lesions. Ten (91%) of 11 vessels wi th or without attached clot rebled versus 0 (0%) of 7 sentinel clots a nd 1 (17%) of 6 lesions without unanimous classification (p < 0.01, ve ssels versus other groups). Rebleeding occurred in 5 (71%) of 7 nonpig mented (pale or white), 6 (38%) of 16 red or purple, and 0 (0%) of 1 b lack protuberances. In general, vessels persisted until rebleeding, wh ereas sentinel clots disappeared within 1 to 3 days. We conclude that nonbleeding protuberances in ulcer bases can be separated into vessels , which have a high risk of rebleeding, and sentinel clots, which have a low risk of rebleeding.