The efficacy of endoscopic therapy in bleeding peptic ulcer patients
Methods. Two hundred and twenty-seven patients with peptic ulcers stratified by Rockall and Forrest scores as at high risk for re-bleeding underwent therapeutic intervention (adrenalin injection) between January 2004 and December 2009. The median age of the patients was 57 years (range 19 - 87 years); 60% were males.
Results. Primary endoscopic haemostasis failed in 51/227 patients (22.5%); 18 patients (7.9%) required surgery for bleeding not controlled at initial or second endoscopy; and 29 patients (12.8%) died, 12 by day 3 and 17 by day 30. Fifteen patients, all with significant medical co-morbidity, died after successful primary endotherapy, and 4 died after surgery. Surgical patients required more blood (odds ratio (OR) 1.45, p=0.0001) than those not undergoing surgery, but had similar mortality. Rebleeding was the only predictor of death in patients who died by day 3 (OR 18.77). A high Rockall score was the only predictor of death by day 30 (OR 1.98).
Conclusion. The overall surgical and mortality rates were 7.9% and 12.8%, respectively. Over half the deaths resulted from medical co-morbidity, despite successful primary endotherapy. This finding is supported by the use of the Rockall score as a predictor of mortality at day 30. Improving the technical success of primary endoscopic haemostasis, currently 77.5%, has the potential to reduce rebleeding after primary endotherapy, a predictor of death at day 3 in this study.
Dion A Levin, Gastrointestinal Clinic, Groote Schuur Hospital and University of Cape Town
Gillian A Watermeyer, Gastrointestinal Clinic, Groote Schuur Hospital and University of Cape Town
Eduan Deetlefs, Gastrointestinal Clinic, Groote Schuur Hospital and University of Cape Town
David C Metz, Department of Internal Medicine, Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia
Sandie R Thomson, Gastrointestinal Clinic, Groote Schuur Hospital and University of Cape Town
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Date published: 2012-03-21
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