Year 2003 / Volume 95 / Number 10
Original
Failure of endoscopic therapy in upper gastrointestinal hemorrhage due to duodenal ulcers

0

P. López Vallejos, Mª V. García Sánchez, A. González Galilea, C. Gálvez Calderón, A. Naranjo Rodríguez, J. L. Montero Álvarez y J. F. de Dios Vega

Abstract
Objectives: to evaluate the efficacy of endoscopic treatment in patients with upper gastrointestinal (UGIH) due to duodenal ulcer with high risk of persistent or recurrent bleeding and to determine
the associated failure factors of this procedure.

Patients and method: three hundred and thirty-six patients with UGIH due to duodenal ulcer requiring endoscopic treatment were analyzed between January 1992 and December 2001. The
patients were classified according to the endoscopic findings: a) patients with limited bleeding; and b) patients with persistent
and/or recurrent bleeding due to therapeutic failure. The clinical guidelines followed in patients with endoscopic treatment failure were previously established in the internal protocol. The variables
that obtained statistical significance in the univariate analysis were included in the logistic regression model to identify those with an
independent predictive value for failure of the endoscopic treatment.

Results: mean age of the patients was 60 ± 17 years, 271 (81%) were male. Bleeding with severe hemodynamic affectation was detected in 82 patients (24%). The most common location of
the duodenal ulcer was on the anterosuperior part of the duodenal bulb (227 patients, 68%). In 43 patients (13%) the ulcer was larger than 2 cm. The bleeding stigmata were classified as: Forrest I
in 125 (38%) and Forrest II in 211 (62%). It was initially reached in 297 patients (88%). Twenty-two patients required emergency surgery (6,5%) and the global mortality rate was 3%. Severe hemodynamic affectation at admission (OR 11.8, p>0.001), ulcers exceeding 2 cm (OR 6.95, p = 0.019) and the presence of active bleeding during endoscopy (Forrest I) (OR 3.55, p = 0.08) were
the variables included in the multivariate analysis independently associated to endoscopic therapy failure.

Conclusion: endoscopic therapy is an efficient treatment of upper gastrointestinal bleeding due to duodenal ulcer. By means of a clinical variable, the hemodynamic status and two endoscopies,
bleeding stigmata and the size of the ulcer, a group of patients with high risk of endoscopic treatment failure can be selected.
Share Button
New comment
Comments
No comments for this article
Related articles
Citation tools
P. López Vallejos, Mª V. García Sánchez, A. González Galilea, C. Gálvez Calderón, A. Naranjo Rodríguez, J. L. Montero Álvarez y J. F. de Dios Vega. Failure of endoscopic therapy in upper gastrointestinal hemorrhage due to duodenal ulcers. 0


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 903 visits.
This article has been downloaded 9 times.
Share
This article has been rated by 1 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology