Endoscopic therapy for peptic ulcer hemorrhage

Practice variations in a multi-center U.S. consortium

Brintha Enestvedt, Ian M. Gralnek, Nora Mattek, David Lieberman, Glenn M. Eisen

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Peptic ulcer disease is a common cause of acute upper gastrointestinal hemorrhage. The aim of this study was to describe the endoscopic management of bleeding peptic ulcers in a large, U.S. multi-center endoscopic consortium with diverse practice settings. Methods: Adult patients who underwent upper endoscopy (EGD) for hematemesis, melena or "suspected upper GI bleed" between January 2000 and December 2004 in the Clinical Outcomes Research Initiative (CORI) endoscopic database were screened for the finding of peptic ulcer. The ulcer stigmata, endoscopic therapy and the need for repeat EGD were compared across practice sites. Results: Of 12,392 patients who underwent EGD for an upper gastrointestinal bleeding indication, 3,692 (30%) had at least one peptic ulcer (clean base 59.9%; flat pigmented spot 13.4%; active bleeding 10.7%; clot 7.2%; non-bleeding visible vessel (NBVV) 6.3%). Endoscopic therapy was applied to 93% of actively bleeding ulcers and 95% of NBVV. Repeat endoscopy was required in 7.3% of patients. Ulcers treated with injection monotherapy had the highest repeat EGD rates (12.2%) compared with contact thermal monotherapy (6.1%) and combination thermal/injection therapy (7.1%) (P = 0.02). Immediate hemostasis rates were 88-97% across all therapeutic modalities. There was no statistical difference in hemostasis rates across therapy nor practice types. Conclusion: In this multi-center consortium, initial hemostasis rates were high across therapy types and sites studied. Injection monotherapy was associated with the highest rates of repeat EGD, supporting guidelines that advise against its use in bleeding peptic ulcers.

Original languageEnglish (US)
Pages (from-to)2568-2576
Number of pages9
JournalDigestive Diseases and Sciences
Volume55
Issue number9
DOIs
StatePublished - Sep 2010

Fingerprint

Peptic Ulcer Hemorrhage
Peptic Ulcer
Hemorrhage
Hemostasis
Ulcer
Endoscopy
Injections
Therapeutics
Hot Temperature
Melena
Hematemesis
Christianity
Gastrointestinal Hemorrhage
Outcome Assessment (Health Care)
Databases
Guidelines

Keywords

  • CORI
  • Endoscopic therapy
  • Endoscopy outcomes
  • Peptic ulcer disease
  • Practice variations
  • Repeat endoscopy

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Endoscopic therapy for peptic ulcer hemorrhage : Practice variations in a multi-center U.S. consortium. / Enestvedt, Brintha; Gralnek, Ian M.; Mattek, Nora; Lieberman, David; Eisen, Glenn M.

In: Digestive Diseases and Sciences, Vol. 55, No. 9, 09.2010, p. 2568-2576.

Research output: Contribution to journalArticle

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abstract = "Background: Peptic ulcer disease is a common cause of acute upper gastrointestinal hemorrhage. The aim of this study was to describe the endoscopic management of bleeding peptic ulcers in a large, U.S. multi-center endoscopic consortium with diverse practice settings. Methods: Adult patients who underwent upper endoscopy (EGD) for hematemesis, melena or {"}suspected upper GI bleed{"} between January 2000 and December 2004 in the Clinical Outcomes Research Initiative (CORI) endoscopic database were screened for the finding of peptic ulcer. The ulcer stigmata, endoscopic therapy and the need for repeat EGD were compared across practice sites. Results: Of 12,392 patients who underwent EGD for an upper gastrointestinal bleeding indication, 3,692 (30{\%}) had at least one peptic ulcer (clean base 59.9{\%}; flat pigmented spot 13.4{\%}; active bleeding 10.7{\%}; clot 7.2{\%}; non-bleeding visible vessel (NBVV) 6.3{\%}). Endoscopic therapy was applied to 93{\%} of actively bleeding ulcers and 95{\%} of NBVV. Repeat endoscopy was required in 7.3{\%} of patients. Ulcers treated with injection monotherapy had the highest repeat EGD rates (12.2{\%}) compared with contact thermal monotherapy (6.1{\%}) and combination thermal/injection therapy (7.1{\%}) (P = 0.02). Immediate hemostasis rates were 88-97{\%} across all therapeutic modalities. There was no statistical difference in hemostasis rates across therapy nor practice types. Conclusion: In this multi-center consortium, initial hemostasis rates were high across therapy types and sites studied. Injection monotherapy was associated with the highest rates of repeat EGD, supporting guidelines that advise against its use in bleeding peptic ulcers.",
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