The visible vessel on the bleeding gastric ulcer: an endoscopic-pathological study

The visible vessel is an important endoscopic sign for predicting rebleeding in ulcers. Freeman has described a visible vessel with a high rate of rebleeding as a "pearl" color (whitish) compared with a darkly colored "sentinel" clot with a low rebleeding rate. Clarifying the color of visible vessels helps to distinguish high-risk bleeding ulcers. We conducted a retrospective study that compared pathological findings with endoscopic pictures to determine the significance of the visible vessel's color.

From January 1986 to December 1992, 110 patients who underwent endoscopy and received subtotal gastrectomies for ulcer bleeding were included in this study. Of these, 24 received endoscopic therapy before the operation. There were 94 males and 16 females, ranging in age from 30 to 90 years, with a mean age of 62.5 years. According to Freeman's report, a subgroup of visible vessels (IIav +) was defined as having either a "pearl-colored" collar around a red or black protruding mount or a "pearl-colored" mount on the ulcer base. The endoscopic findings were compared with the findings of the pathological specimens.

The endoscopic findings on the stigmata of recent hemorrhage in the 110 patients revealed that 31 were of type IIa (including 18 type IIav+ and 13 type IIav-), 56 of type IIb, 18 of type IIc, and 5 of type III. Fifty-four patients (49,1%) were found from their pathological specimen to have an eroded vessel on their ulcer base. Type IIa patients had a higher percentage of eroded vessels. The percentages of eroded vessels in types IIa, IIb, IIc, and III were 67.7%, 46.4%, 33.3%, and 20 %, respectively (P < 0.05, Fisher's exact test). Of the 54 patients with an eroded vessel in their pathological specimen, 13 (24 %) were found to have some vessel wall above the ulcer base (six in type IIa, four in type IIb, two in type IIc, and one in type III). Among the six with vessel wall above the ulcer base in type IIa, five patients (83 %) were identified as type IIav+ under endoscopy. There was a greater frequency of having a vessel wall above the ulcer base in type IIav+ than in type IIav- (38.5% vs. 12.5%) among the 31 endoscopic type IIa patients.

From this study, we determined that the wall of an eroded vessel on a gastric ulcer may protrude either above or below the ulcer base. A vessel wall on the ulcer base will appear pearl-colored under endoscopic view.