Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers

作     者：Ming-Luen Hu King-Wah Chiu Yi-Chun Chiu Yeh-Pin Chou Tsung-Hui Hu Shue-Shian Chiou Seng-Kee Chuah 

作者机构：Division of Hepatogastroenterology Department of Internal Medicine Chang Gung Memorial Hospital-Kaohsiung Medical Center Chang Gung University College of Medicine 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2010年第16卷第43期

页      面：5490-5495页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：Supported by No Financial Interests or Grants support that might have an impact on the views expressed in this study 

主　　题：Epinephrine injection High-risk ulcers Initial hemostasis Predictors Rebleeding 

摘      要：AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding. RESULTS: A total of 175 patients (144, sustainedhemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category Ⅲ , Ⅳ and Ⅴ ), shock, severe anemia (hemoglobin 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications. CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.