Role of Doppler US in acute peptic ulcer hemorrhage: Can it predict failure of endoscopic therapy?

Background: Recurrent bleeding after successful primary endoscopic hemostas is of acutely bleeding ulcers is a significant problem. This study evaluate s endoscopic Doppler ultrasound (US) in assessing risk of recurrent bleedin g in patients presenting with acute peptic ulcer hemorrhage, Methods: In this prospective, double-blind, nonrandomized trial, patients w ere enrolled from a single academic institution. Only patients with endosco pically confirmed gastric, duodenal, pyloric, or anastomotic ulcers were en rolled. The therapeutic endoscopist was blinded to the Doppler US signal fr om the ulcer and based treatment decisions on standard guidelines, A 16 MHz pulsed-wave, linear scanning, US probe was used through the accessory chan nel of an endoscope to assess for the presence of a Doppler signal. Results: Fifty-two of 139 screened patients entered the trial (55 Doppler s essions), Endoscopic therapy was performed in 42% (30-day recurrent bleedin g rate of 17%), Ulcers that remained persistently Doppler positive immediat ely after endoscopic therapy had a significantly higher rate of recurrent b leeding than ulcers where the Doppler signal was abolished: 100% versus 11% (p = 0.003). There were no bleeding-related deaths. Conclusions: A persistently positive Doppler US signal appears to be a mark er of inadequate endoscopic therapy in patients with acutely bleeding pepti c ulcers.