What kind of non-bleeding visible vessel in a peptic ulcer needs aggressive therapy? Long-term clinical observation

A total of 57 patients with peptic ulcers showing non-bleeding visible vessels were followed for 1-26 months (mean +/- SEM: 13.8 +/- 1.7 months). The age was 56.2 +/- 2.1 years (mean +/- SEM). Blood transfusion with a mean volume of 3.89 units was given. Twenty-five (25/57, 43.9%) patients had rebleeding episodes within one month. Seventeen (17/57, 29.8%) patients were submitted to operation or therapeutic endoscopy due to failure of hemostasis. We analyzed eight clinical parameters on admission of these patients with the aid of a stepwise logistic regression test. Advanced age (over 60), blood transfusion of more than 500 ml and shock were found to be independent predictors of rebleeding. Advanced age (over 60) and coffee ground material in the stomach were found to be independent predictors of ultimate failure of conservative management. We recommend aggressive (either operation or therapeutic endoscopy) rather than conservative management in a patient with a non-bleeding visible vessel who has any of the following characteristics on admission: age over 60, volume of blood transfusion over 500 ml, shock and coffee ground material in the stomach.