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Results for “PEPTIC ULCER HEMORRHAGE”

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At least 19 recordsLinked to original sources
PubMedDate not supplied

How efficient is endoscopic injection sclerotherapy in peptic ulcer hemorrhage.

BACKGROUND/AIMS: Peptic ulcer hemorrhage is a common, worldwide problem and a major cause of morbidity and mortality. The aim of this study was to establish the percentage of patients with bleeding peptic ulcers who were treated surgically because endoscopy failed to stop the hemorrhage. METHODOLOGY: This retrospective analysis includes patients from our institution who underwent urgent endoscopic examination of the upper digestive tract and hemostatic interventions with injection therapy (sol. 1:10000 adrenaline and 1% polidocanol) between January, 1994 and November, 1995. RESULTS: Two hundred thirty-three patients with bleeding peptic ulcers were examined: 111 with bleeding gastric ulcers (66 males, 45 females; average age 60.21 years, SD +/- 13.94; span 28-94 years) and 122 with bleeding duodenal ulcers (95 males, 27 females; average age 55.24 years, SD +/- 17.35; span 16-88 years). In all patients, injection sclerotherapy was performed. The ulcers were classified according to Forrest's classification of bleeding activity. In 10 patients (4.2%) with acute hemorrhage (6 males; average age 63.2 years, SD +/- 5.6; span 53-70 years: 4 females, average age 61.0 years, SD +/- 11.82; span 51-81 years), endoscopic hemostasis did not prove successful and they were treated operatively. In 5 cases, the cause of hemorrhage was a gastric ulcer and in 5 others, duodenal ulcer. During the postoperative period, 5 patients died of complications. CONCLUSIONS: Endoscopic hemostasis has been a major therapeutic advancement in the management of peptic ulcer hemorrhage and has influenced surgical management. Injection sclerotherapy is a low cost, effective and safe procedure which is easy to implement in a variety of clinical settings. Early elective operation after initial endoscopic hemostasis is the wisest choice for elderly patients with co-existing disease and selected patients at high risk for recurrent bleeding.

Adult↗
PubMedDate not supplied

Argon plasma coagulation versus injection sclerotherapy in peptic ulcer hemorrhage--a prospective, controlled study.

BACKGROUND/AIMS: In Slovenia, the annual incidence of peptic ulcer hemorrhage is 118/100,000 inhabitants, with mortality up to 14%. Interventional endoscopy has largely reduced mortality in these patients. This study aims to evaluate the efficacy and safety of argon plasma coagulation and injection sclerotherapy in bleeding peptic ulcer. METHODOLOGY: A prospective, controlled study which includes 100 patients with peptic ulcer hemorrhage (male 63, female 37, av.age 57.1 years, SD+/-16, span 26-80; gastric ulcer 50 patients, duodenal ulcer 50 patients) in the period between 1.01.1999 and 15.05.2000 treated in our institution. The bleeding activity was determined according to the Forrest classification. Fifty patients were randomized to receive argon plasma coagulation (ARCO 2000 ES unit, group A) and in fifty patients injection sclerotherapy (sclerosing with diluted adrenalin 1:10,000 plus polidocanol 1%, group B) was performed. The groups did not differ with respect to age, sex, site, severity of bleeding, use of NSAID and additional diseases. RESULTS: Clinically and endoscopically diagnosed rebleeding occured in 7/50 patients (14%) in group A and in 9/50 patients (18%) in group B; p=0.78. The majority of rebleeding occured within 48 hours after endoscopic hemostasis, group A 4-/7 (57.1%), group B 7/9 (77.7%), p = 0.74. Repeated endoscopic hemostasis did not prove successful in 8 patients (group A 3/50, 6%, group B 5/50, 10%), p=0.71. Seven patients were treated operatively. The total mortality rate was 9% (9/100 patients, group A 4/50, 8%, group B 5/50, 10%), p>0.05. Only one patient died due to peptic ulcer hemorrhage, other 8 patients died due to concomitant diseases. CONCLUSIONS: Argon plasma coagulation seems to be an effective and safe alternative to other hemostatic modalities in peptic ulcer hemorrhage.

Adult↗
PubMed2006

Endoscopic Doppler ultrasound versus endoscopic stigmata-directed management of acute peptic ulcer hemorrhage: a multimodel cost analysis.

Recurrent bleeding from acute peptic ulcer hemorrhage is problematic. Studies have shown that Doppler ultrasound (DOP-US) is useful in decreasing rebleeding. We analyzed associated costs and outcomes to better define the role of DOP-US versus Conventional (Forrest classification endoscopic stigmata) in the management of acute peptic ulcer bleeding. Two separate decision analyses were constructed. Recurrent bleeding, failed esophagogastroduodenoscopy (EGD) hemostasis, complications, and surgery rates were derived from medical literature. Costs were based on Medicare data. DOP-US is preferred over Conventional in acute peptic ulcer bleeding with average cost savings per patient ranging from 853 dollars (decision-tree modeling) to 1,160 dollars (Monte Carlo simulation). High-dose intravenous proton-pump inhibitors lowered rates of recurrent bleeding for both Conventional and DOP-US, resulting in a lower but still persistent average cost savings per patient for DOP-US (decision-tree modeling = 328 dollars, Monte Carlo simulation = 560 dollars). This decision analyses identified DOP-US as the preferred cost-minimizing strategy in acute peptic ulcer hemorrhage. Results of cost analyses were most dependent on hospitalization costs and recurrent bleeding rates.

Acute Disease↗
PubMed1994

[Risk factors of persistent or recurrent bleeding and mortality in peptic ulcer hemorrhage].

The mortality rate of peptic ulcer haemorrhage has remained unchanged, mainly attributed to rebleeding in an increasingly elderly population with more coexisting systemic diseases. The value of clinical factors and endoscopic findings in predicting in-hospital further haemorrhage and death are analysed. Over a 2-year period, 157 consecutive patients were admitted with bleeding from peptic ulcer, 19 died and 37 had further bleeding. The predictive value of each factor was determined by the chi 2 test with a Yates-correction (significant, p < 0.05). Significant predictive factors of further bleeding were shock, a transfusion requirement > 4 units during the first 48 hours and endoscopic stigmata of recent haemorrhage. The combination of these factors was not of better predictive value than shock alone. The number of coexisting illnesses per patient was strongly related to fatality rate. Other significant factors indicative of an increased mortality included steroid, onset of bleeding during a hospital stay, alcohol, further bleeding, and > 4 units transfused over the first 48 hours. Shock remains the most valuable sign in predicting further bleeding and is superior to endoscopic stigmata. The close relationship between the mortality rate and coexisting illnesses underlines the fact that the majority of deaths result from non peptic ulcer disease.

Aged↗
PubMed1995

[Risk factors of peptic ulcer hemorrhage].

A retrospective analysis is made of the risk factors in 229 patients admitted to hospital with hemorrhage from peptic ulcer. The factors that have been studied are: 1) age. 2) type of ulcer lesion. 3) associated disease. 4) antiinflammatory intake. 5) prior ulcer symptoms. 6) intensity and outcome of the bleeding episode. 7) endoscopic findings. 8) treatment modality. 9) mortality. The analysis of these factors tries to establish, by means of the square chi test with Yates correction, the possible relations between the factors, to determine which ones will have a pronostic value. From the results obtained we conclude that the factors with the highest pronostic importance are: 1) With respect to the severity of the bleeding episode, antiinflammatory intake and duodenal location of the ulcer lesion. 2) With respect to the need for urgent surgical treatment, antiinflammatory intake and prior ulcer symptoms. 3) With respect to mortality, severity, persistence and recurrence of bleeding, and the need for urgent surgical treatment. Finally, it is important to mention the absence of pronostic value, with respect to mortality, of advanced age and the endoscopic findings of active and/or recent bleeding.

Acute Disease↗
PubMed1993

[The prognostic value of the endoscopic signs in the recurrence of peptic ulcer hemorrhage].

The endoscopic signs of hemorrhage in bleeding peptic ulcers are considered as prognostic factors for rebleeding and mortality. The value of these signs has been examined in several studies of patients with known high risk factors. In this survey, we studied the prognostic value of the endoscopic signs of hemorrhage in bleeding peptic ulcer in a group of patients without clinical risk factors such as age > 60 years, concomitant malignancy or respiratory and heart disease. Endoscopic findings were examined in fifty patients without rebleeding (group I) and twenty five with rebleeding (group II). Endoscopic findings results were spurting arterial bleeding in 9.3% of the cases, oozing hemorrhage in 17.3% of the cases, visible vessel in 9.3% of the cases, and adherent clot in 82.3% of the cases. In 9.3% of the cases endoscopic findings were negative. No statistical differences were found in the endoscopic signs among the two groups. The visible vessel and the spurting arterial bleeding cases presented in more than 50% of the rebleeding, (visible vessel and spurting arterial 57.1%). Oozing hemorrhage and the adherent clot were present in 30% of the cases. The endoscopic signs of bleeding can assist in choosing the group of patients with prospective high risk of rebleeding and possible candidates for the new treatment of endoscopic hemostatic therapy.

Adult↗