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. 1994 Oct;35(10):1389–1393. doi: 10.1136/gut.35.10.1389

Clinical courses and predictors for rebleeding in patients with peptic ulcers and non-bleeding visible vessels: a prospective study.

H J Lin 1, C L Perng 1, F Y Lee 1, C H Lee 1, S D Lee 1
PMCID: PMC1375011  PMID: 7959193

Abstract

Detailed characterisation of non-bleeding visible vessels in terms of colour, size evolution, and time of rebleeding is important in determining the natural history of these lesions. The colour and size of non-bleeding visible vessels were observed endoscopically every day for three days and then every other day until rebleeding or flattening of visible vessels occurred in 140 patients. Rebleeding happened in 61 (44%) patients. Of them, 59 (97%) rebled within 72 hours. Flattening of visible vessels happened in 79 (56%) patients and 77 of 79 (98%) had flattening of visible vessels within 72 hours. Rebleeding rate increased with increasing length of exposed vessels (r = 0.96, p < 0.001). Coffee ground fluid or blood retention in the stomach and ulcer size > or = 2.0 cm were independent predictors for rebleeding using multivariate analysis. It is suggested that patients with non-bleeding visible vessels and independent predictors for rebleeding may need early aggressive treatment.

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Selected References

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  1. Allan R., Dykes P. A study of the factors influencing mortality rates from gastrointestinal haemorrhage. Q J Med. 1976 Oct;45(180):533–550. [PubMed] [Google Scholar]
  2. Bornman P. C., Theodorou N. A., Shuttleworth R. D., Essel H. P., Marks I. N. Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: a prospective evaluation. Br Med J (Clin Res Ed) 1985 Jul 27;291(6490):245–247. doi: 10.1136/bmj.291.6490.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Branicki F. J., Boey J., Fok P. J., Pritchett C. J., Fan S. T., Lai E. C., Mok F. P., Wong W. S., Lam S. K., Hui W. M. Bleeding duodenal ulcer. A prospective evaluation of risk factors for rebleeding and death. Ann Surg. 1990 Apr;211(4):411–418. doi: 10.1097/00000658-199004000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chang-Chien C. S., Wu C. S., Chen P. C., Lin D. Y., Chu C. M., Fang K. M., Sheen I. S., Liaw Y. F. Different implications of stigmata of recent hemorrhage in gastric and duodenal ulcers. Dig Dis Sci. 1988 Apr;33(4):400–404. doi: 10.1007/BF01536021. [DOI] [PubMed] [Google Scholar]
  5. Clason A. E., Macleod D. A., Elton R. A. Clinical factors in the prediction of further haemorrhage or mortality in acute upper gastrointestinal haemorrhage. Br J Surg. 1986 Dec;73(12):985–987. doi: 10.1002/bjs.1800731213. [DOI] [PubMed] [Google Scholar]
  6. Domschke W., Lederer P., Lux G. The value of emergency endoscopy in upper gastrointestinal bleeding: review and analysis of 2014 cases. Endoscopy. 1983 May;15 (Suppl 1):126–131. doi: 10.1055/s-2007-1021486. [DOI] [PubMed] [Google Scholar]
  7. Fleischer D. Etiology and prevalence of severe persistent upper gastrointestinal bleeding. Gastroenterology. 1983 Mar;84(3):538–543. [PubMed] [Google Scholar]
  8. Freeman M. L., Cass O. W., Peine C. J., Onstad G. R. The non-bleeding visible vessel versus the sentinel clot: natural history and risk of rebleeding. Gastrointest Endosc. 1993 May-Jun;39(3):359–366. doi: 10.1016/s0016-5107(93)70106-6. [DOI] [PubMed] [Google Scholar]
  9. Fullarton G. M., Birnie G. G., Macdonald A., Murray W. R. Controlled trial of heater probe treatment in bleeding peptic ulcers. Br J Surg. 1989 Jun;76(6):541–544. doi: 10.1002/bjs.1800760606. [DOI] [PubMed] [Google Scholar]
  10. Fullarton G. M., Murray W. R. Prediction of rebleeding in peptic ulcers by visual stigmata and endoscopic Doppler ultrasound criteria. Endoscopy. 1990 Mar;22(2):68–71. doi: 10.1055/s-2007-1012795. [DOI] [PubMed] [Google Scholar]
  11. Gilbert D. A., Silverstein F. E., Tedesco F. J., Buenger N. K., Persing J. The national ASGE survey on upper gastrointestinal bleeding. III. Endoscopy in upper gastrointestinal bleeding. Gastrointest Endosc. 1981 May;27(2):94–102. doi: 10.1016/s0016-5107(81)73157-2. [DOI] [PubMed] [Google Scholar]
  12. Griffiths W. J., Neumann D. A., Welsh J. D. The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med. 1979 Jun 21;300(25):1411–1413. doi: 10.1056/NEJM197906213002503. [DOI] [PubMed] [Google Scholar]
  13. JONES F. A. Hematemesis and melena; with special reference to causation and to the factors influencing the mortality from bleeding peptic ulcers. Gastroenterology. 1956 Feb;30(2):166–190. [PubMed] [Google Scholar]
  14. Jensen D. M. Heat probe for hemostasis of bleeding peptic ulcers: technique and results of randomized controlled trials. Gastrointest Endosc. 1990 Sep-Oct;36(5 Suppl):S42–S49. [PubMed] [Google Scholar]
  15. Jensen H. E., Hoffmann J., Wille-Jørgensen P. High gastric ulcer. World J Surg. 1987 Jun;11(3):325–332. doi: 10.1007/BF01658110. [DOI] [PubMed] [Google Scholar]
  16. Jones P. F., Johnston S. J., McEwan A. B., Kyle J., Needham C. D. Further haemorrhage after admission to hospital for gastrointestinal haemorrhage. Br Med J. 1973 Sep 29;3(5882):660–664. doi: 10.1136/bmj.3.5882.660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kang J. Y., Nasiry R., Guan R., Labrooy S., Lim K. P., Yap I., Piper D. W. Influence of the site of a duodenal ulcer on its mode of presentation. Gastroenterology. 1986 Jun;90(6):1874–1876. doi: 10.1016/0016-5085(86)90255-6. [DOI] [PubMed] [Google Scholar]
  18. Krejs G. J., Little K. H., Westergaard H., Hamilton J. K., Spady D. K., Polter D. E. Laser photocoagulation for the treatment of acute peptic-ulcer bleeding. A randomized controlled clinical trial. N Engl J Med. 1987 Jun 25;316(26):1618–1621. doi: 10.1056/NEJM198706253162602. [DOI] [PubMed] [Google Scholar]
  19. Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. A prospective controlled trial. N Engl J Med. 1987 Jun 25;316(26):1613–1617. doi: 10.1056/NEJM198706253162601. [DOI] [PubMed] [Google Scholar]
  20. Laine L. Multipolar electrocoagulation in the treatment of peptic ulcers with nonbleeding visible vessels. A prospective, controlled trial. Ann Intern Med. 1989 Apr 1;110(7):510–514. doi: 10.7326/0003-4819-110-7-510. [DOI] [PubMed] [Google Scholar]
  21. Lin H. J., Lee F. Y., Kang W. M., Tsai Y. T., Lee S. D., Lee C. H. Heat probe thermocoagulation and pure alcohol injection in massive peptic ulcer haemorrhage: a prospective, randomised controlled trial. Gut. 1990 Jul;31(7):753–757. doi: 10.1136/gut.31.7.753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Lin H. J., Lee F. Y., Tsai Y. T., Lee S. D., Lee C. H. What kind of non-bleeding visible vessel in a peptic ulcer needs aggressive therapy? Long-term clinical observation. Endoscopy. 1990 Jan;22(1):8–11. doi: 10.1055/s-2007-1012778. [DOI] [PubMed] [Google Scholar]
  23. MacLeod I. A., Mills P. R. Factors identifying the probability of further haemorrhage after acute upper gastrointestinal haemorrhage. Br J Surg. 1982 May;69(5):256–258. doi: 10.1002/bjs.1800690509. [DOI] [PubMed] [Google Scholar]
  24. Matre K., Odegaard S., Hausken T. Endoscopic ultrasound Doppler probes for velocity measurements in vessels in the upper gastrointestinal tract using a multifrequency pulsed Doppler meter. Endoscopy. 1990 Nov;22(6):268–270. doi: 10.1055/s-2007-1012867. [DOI] [PubMed] [Google Scholar]
  25. Matthewson K., Swain C. P., Bland M., Kirkham J. S., Bown S. G., Northfield T. C. Randomized comparison of Nd YAG laser, heater probe, and no endoscopic therapy for bleeding peptic ulcers. Gastroenterology. 1990 May;98(5 Pt 1):1239–1244. doi: 10.1016/0016-5085(90)90339-3. [DOI] [PubMed] [Google Scholar]
  26. Northfield T. C. Factors predisposing to recurrent haemorrhage after acute gastrointestinal bleeding. Br Med J. 1971 Jan 2;1(5739):26–28. doi: 10.1136/bmj.1.5739.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. OSBORN G. R. The pathology of gastric arteries, with special reference to fatal haemorrhage from peptic ulcer. Br J Surg. 1954 May;41(170):585–594. doi: 10.1002/bjs.18004117006. [DOI] [PubMed] [Google Scholar]
  28. Panés J., Viver J., Forné M., Garcia-Olivares E., Marco C., Garau J. Controlled trial of endoscopic sclerosis in bleeding peptic ulcers. Lancet. 1987 Dec 5;2(8571):1292–1294. doi: 10.1016/s0140-6736(87)91191-3. [DOI] [PubMed] [Google Scholar]
  29. Peterson W. L. Therapeutic endoscopy and bleeding ulcers. Clinical risk factors. Gastrointest Endosc. 1990 Sep-Oct;36(5 Suppl):S14–S15. [PubMed] [Google Scholar]
  30. Rutgeerts P., Vantrappen G., Broeckaert L., Janssens J., Coremans G., Geboes K., Schurmans P. Controlled trial of YAG laser treatment of upper digestive hemorrhage. Gastroenterology. 1982 Aug;83(2):410–416. [PubMed] [Google Scholar]
  31. Schiller K. F., Truelove S. C., Williams D. G. Haematemesis and melaena, with special reference to factors influencing the outcome. Br Med J. 1970 Apr 4;2(5700):7–14. doi: 10.1136/bmj.2.5700.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Sheppard M. C., Holmes G. K., Cockel R. Clinical picture of peptic ulceration diagnosed endoscopically. Gut. 1977 Jul;18(7):524–530. doi: 10.1136/gut.18.7.524. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Storey D. W., Bown S. G., Swain C. P., Salmon P. R., Kirkham J. S., Northfield T. C. Endoscopic prediction of recurrent bleeding in peptic ulcers. N Engl J Med. 1981 Oct 15;305(16):915–916. doi: 10.1056/NEJM198110153051603. [DOI] [PubMed] [Google Scholar]
  34. Swain C. P., Storey D. W., Bown S. G., Heath J., Mills T. N., Salmon P. R., Northfield T. C., Kirkham J. S., O'Sullivan J. P. Nature of the bleeding vessel in recurrently bleeding gastric ulcers. Gastroenterology. 1986 Mar;90(3):595–608. doi: 10.1016/0016-5085(86)91113-3. [DOI] [PubMed] [Google Scholar]
  35. Turner I. B., Jones M., Piper D. W. Factors influencing mortality from bleeding peptic ulcers. Scand J Gastroenterol. 1991 Jun;26(6):661–666. doi: 10.3109/00365529109043641. [DOI] [PubMed] [Google Scholar]
  36. Vallon A. G., Cotton P. B., Laurence B. H., Armengol Miro J. R., Salord Oses J. C. Randomised trial of endoscopic argon laser photocoagulation in bleeding peptic ulcers. Gut. 1981 Mar;22(3):228–233. doi: 10.1136/gut.22.3.228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Wara P. Endoscopic prediction of major rebleeding--a prospective study of stigmata of hemorrhage in bleeding ulcer. Gastroenterology. 1985 May;88(5 Pt 1):1209–1214. doi: 10.1016/s0016-5085(85)80081-0. [DOI] [PubMed] [Google Scholar]
  38. Wara P., Stødkilde H. Bleeding pattern before admission as guideline for emergency endoscopy. Scand J Gastroenterol. 1985 Jan;20(1):72–78. doi: 10.3109/00365528509089635. [DOI] [PubMed] [Google Scholar]

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