Endoscopic factors predisposing to rebleeding following endoscopic hemostasis in bleeding peptic ulcers

Background and Study Aims: Various clinical and endoscopic factors have bee n proposed and used as predictors of endoscopic treatment failure in bleedi ng peptic ulcers. Recently, several endoscopic factors have been considered to be more significant than various clinical factors, except for shock. De tailed knowledge of which endoscopic factors can be classified as predictor s of rebleeding following endoscopic hemostasis is needed. This study descr ibes newly defined endoscopic variables and evaluates their usefulness as p redictors of endoscopic treatment failure. Patients and Methods: Between January 1996 and April 1999, diagnostic and t herapeutic endoscopies were carried out in 143 patients with active bleedin g peptic ulcers. Nine clinical and eight endoscopic variables were studied. Endoscopic factors were classified by three types of stigmata bleeding, 14 locations, two ulcer sizes, three ulcer bases, three visible vessel colors , two ulcer depths, two margin shapes, and three endoscopic treatment metho ds (injection, hemoclipping, and combination). Results: 36 patients experienced rebleeding (25.2%), 11 patients needed ope rations (7.7%) and five deaths occurred (3.5%). In univariate analysis, reb leeding was significantly related to: i) presence of spurting activity (odd s ratio [OR] = 4.91, P = 0.006), ii) ulcer size larger than 2 cm (OR = 2.78 , P = 0.017); and iii) location in stomach (OR = 2.81, P = 0.026). Clinical variables including age, shock, and initial hemoglobin levels were not sig nificantly related to rebleeding. In multiple logistic regression using sel ected significant variables, presence of spurting activity remained a signi ficant independent predictor of rebleeding (adjusted OR = 6.48, P = 0.003). Conclusion: Our data support the hypothesis that endoscopic factors are mor e important than clinical ones when predicting rebleeding of peptic ulcers. Based on statistical analysis of risk factors, the ulcers most likely to r ebleed after endoscopic therapy are those which are located in the stomach, are greater than 2 cm in diameter and exhibit oozing or spurting of blood.