Predictors of hemostatic failure after adrenaline injection in patients with peptic ulcers with non‐bleeding visible vessel

Abstract

Background: Non‐bleeding visible vessel (NBVV) in patients with bleeding peptic ulcer is associated with a high risk of rebleeding. The aim of this study was to define factors associated with failure of endoscopic hemostasis and rebleeding in patients with NBVV. Methods: Clinical and endoscopic parameters related to failure of endoscopic hemostasis with adrenaline in 191 bleeding peptic ulcer patients with NBVV were evaluated. Results: Endoscopic hemostasis was permanently successful in 154 patients (80.6%). Emergency surgical hemostasis for rebleeding was required in 37 patients (19.4%). Univariate analysis showed that therapeutic failure was significantly related to the presence of shock on admission (P = 0.003), posterior duodenal ulcers (P = 0.001), peptic ulcer history (P = 0.001), previous peptic ulcer bleeding (P = 0.002), or lack of history of non‐steroidal anti‐inflammatory drugs consumption, when compared to use of such drugs (P = 0.04). Patients where therapy failed had lower hemoglobin levels at admission (7.8 ± 1.9 g/dL versus 10 ± 2.4 g/dL, P = 0.005). In a multivariate analysis low hemoglobin (P < 0.001) as well as history of previous peptic ulcer bleeding (P = 0.002) and posterior duodenal ulcers (P = 0.001) were negative predictors. Using the mean value of hemoglobin as the cut‐off point, it is noteworthy that only 2 out of 81 patients (2.5%) who had none of these predictive factors required emergency surgical hemostasis, whereas 34 out of 110 patients (30.9%) with at least one predictive factor required emergency surgery. Conclusion: It is possible, by employing specific characteristics, to define a subgroup of high‐risk patients for rebleeding in patients with NBVV despite therapeutic endoscopy and thus candidates for a complementary endoscopic method of hemostasis or emergency surgical intervention.

• Adrenaline injection
• endoscopic hemostasis
• non‐bleeding visible vessel
• peptic ulcer bleeding
• rebleeding