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Doppler endoscopic probe as a guide to risk stratification and definitive hemostasis of peptic ulcer bleeding
Dennis M Jensen1, Gordon V Ohning1, Thomas O G Kovacs1
1CURE Hemostasis Research Group of the CURE Digestive Diseases Research Center, Divisions of Digestive Diseases and Departments of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, Calif, USA; West Los Angeles Veterans Administration Medical Center, Los Angeles, Calif, USA.
Insights
Doppler endoscopic probes detect arterial blood flow under ulcer stigmata, improving risk stratification for peptic ulcer bleeding (PUB). This new method enhances hemostasis and reduces rebleeding rates compared to traditional assessments.
Area of Science:
- Gastroenterology
- Endoscopic technology
- Hemorrhage management
Background:
- Endoscopists traditionally use ulcer stigmata for risk stratification and hemostasis in peptic ulcer bleeding (PUB).
- Arterial blood flow beneath stigmata has not been utilized to predict outcomes.
- Severe PUB necessitates improved risk stratification and hemostasis guidance.
Purpose of the Study:
- To utilize a Doppler endoscopic probe (DEP) for detecting arterial blood flow under stigmata of recent hemorrhage (SRH).
- To quantify residual arterial blood flow after endoscopic treatment.
- To compare rebleeding risks and rates between spurting (Forrest IA) and oozing (Forrest IB) arterial bleeding.
Main Methods:
- Prospective cohort study of 163 consecutive patients with severe PUB.
- Utilized a Doppler endoscopic probe (DEP) to detect arterial blood flow under SRH.
- Compared DEP findings and 30-day rebleeding rates for different Forrest classifications.
Main Results:
- Doppler endoscopic probe (DEP) detected arterial blood flow in 87.4% of major bleeding (Forrest IA) and 42.3% of oozing (Forrest IB) ulcers.
- Spurting arterial bleeding (Forrest IA) showed higher baseline and residual blood flow (35.7%) than oozing (Forrest IB) after treatment.
- 30-day rebleeding rates were significantly higher for spurting (28.6%) versus oozing (0%) arterial bleeding (Forrest IA vs. IB).
Conclusions:
- Doppler endoscopic probe (DEP) significantly differentiates rebleeding risk based on arterial blood flow under stigmata of recent hemorrhage (SRH).
- Spurting arterial bleeding (Forrest IA) demonstrates higher blood flow and rebleeding rates than oozing (Forrest IB) PUB.
- DEP is recommended for improved risk stratification and hemostasis in peptic ulcer bleeding (PUB).
Background And Aims:
For more than 4 decades endoscopists have relied on ulcer stigmata for risk stratification and as a guide to hemostasis. None used arterial blood flow underneath stigmata to predict outcomes. For patients with severe peptic ulcer bleeding (PUB), we used a Doppler endoscopic probe (DEP) for (1) detection of blood flow underlying stigmata of recent hemorrhage (SRH), (2) quantitating rates of residual arterial blood flow under SRH after visually directed standard endoscopic treatment, and (3) comparing risks of rebleeding and actual 30-day rebleed rates for spurting arterial bleeding (Forrest [F] IA) and oozing bleeding (F IB).
Methods:
Prospective cohort study of 163 consecutive patients with severe PUB and different SRH.
Results:
All blood flow detected by the DEP was arterial. Detection rates were 87.4% in major SRH-spurting arterial bleeding (F IA), non-bleeding visible vessel (F IIA), clot (F IIB)-and were significantly lower at 42.3% (P < .0001) for an intermediate group of oozing bleeding (F IB) or flat spot (F IIC). For spurting bleeding (F IA) versus oozing (F IB), baseline DEP arterial flow was 100% versus 46.7%, residual blood flow detected after endoscopic hemostasis was 35.7% versus 0%, and 30-day rebleed rates were 28.6% versus 0% (all P < .05).
Conclusions:
(1) For major SRH versus oozing or spot, the arterial blood flow detection rate by the DEP was significantly higher, indicating a higher rebleed risk. (2) Before and after endoscopic treatment, spurting (F IA) PUB had significantly higher rates of blood flow detection than oozing (F IB) PUB and a significantly higher 30-day rebleed rate. (3) The DEP is recommended as a new endoscopic guide with SRH to improve risk stratification and potentially definitive hemostasis for PUB.
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