Korean Journal of Gastrointestinal Endoscopy 2008;37(2): 83-89.
소화성 궤양 출혈에서 지혈 클립 후 재출혈의 예측인자: 클립 지혈 단독요법과 에피네프린 국소 주사와의 병합요법 비교
오효정ㆍ김태현ㆍ서검석ㆍ최창수ㆍ조은영ㆍ김기훈ㆍ서승오ㆍ권지혜ㆍ류한승ㆍ최석채ㆍ김학철ㆍ신새론*
원광대학교 의과대학 소화기내과학교실, 소화기질환 연구소, *가정의학교실
Predictors of Rebleeding after Hemoclip Therapy for Treating High-risk Bleeding Ulcers: Hemoclip Therapy Alone was Comparable to Combination Treatmentwith Epinephrine Injection
Hyo Jeong Oh, M.D., Tae Hyeon Kim, M.D., Geom Seog Seo, M.D., Chang Soo Choi, M.D., Eun Young Cho, M.D., Ki Hoon Kim, M.D., Sung O Seo, M.D., Ji Hye Kweon, M.D., Han Seung Ryu, M.D.,Suck Chei Choi, M.D., Haak Cheoul Kim, M.D. and Sae Ron Shin, M.D.*
Departments of Internal Medicine, *Family Medicine, and Digestive Disease Research Institute, College of Medicine, Wonkwang University College of Medicine, Iksan, Korea
Abstract
Background/Aims: Active bleeding and non-bleeding visible vessels in patients with bleeding peptic ulcer are associated with a high risk of rebleeding. The aim of our study was to define the risk factors associated with failure of endoscopic hemostasis and rebleeding in patients with active peptic ulcer bleeding. Methods: We retrospectively reviewed 119 patients (90 men and 29 women; mean age, 60.14±14.67 years) with active peptic ulcer bleeding (spurting, oozing and/or non-bleeding visible vessel) and who were treated in Wonkwang Medical Center from January 2002 to January 2007. They were classified to endoscopic hemoclipping alone group (n=75) or endoscopic hemoclipping combined with epinephrine injection group (n=44), according to the therapeutic modality. Results: Initial hemostasis was achieved in the two groups (100%), and permanent hemostasis was achieved 71.4% in all the patients. Operation was done in eight patients (6.7%), and six patients (5%) in the two groups, respectively, died within 1 month after initial hemostasis because of bleeding related complications. Recurrent bleeding, the duration of the hospital stay, blood transfusion requirements, complications and the operation and mortality rates were not statistically different between the hemoclip alone and combination groups. Univariate analysis showed that rebleeding was related to the presence of shock on admission (p=0.01), complication (p=0.00), the pulse rate (＞100/min) on admission (p=0.04), single ulcer (p=0.032), the level of hemoglobin (＜8 g/dL) (p=0.02) and the volume of transfusion (＞3 units) after the procedure (p=0.005) in all the patients. On the multivariate analysis that was adjusted for age and gender, the hemoglobin level (＜8 g/dL) (odds ratio = 10.5) was the only significant predictor for early rebleeding. Conclusions: This result may suggest that the combination method does not provide a substantial advantage over hemoclipping alone for the hemostatic management of active peptic ulcers bleeding. A low hemoglobin level on admission may be useful to predict rebleeding after initial endoscopic hemostasis in patients with active peptic ulcer. However, this study was designed retrospectively, so the comparison between these two groups should be re-evaluated prospectively in a large, multicenter trial. (Korean J Gastrointest Endosc 2008;37:83-89)
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