Predictive Factors for Endoscopic Hemostasis in Patients with Upper Gastrointestinal Bleeding

(UGIB) is the most common gastrointestinal emergency; the annual incidence of hospital admission for UGIB is 0.1%. The most common cause is peptic ulcer bleeding (PUB), which is noted in 31% to 67% of all cases. 1 Mortality rates have remained unchanged at 6% to 8% because of patient characteristics such as older age, higher incidence of concurrent illness, and high hospitalized chance. 2 Endoscopic treatment of UGIB has recently advanced by the administration of high-dose intravenous proton pump inhibitors (PPIs). It has been noted that 70% of patients with UGIB stop bleeding spontaneously without recurrence, 10% bleed continuously, and 20% experience continued or recurrent bleeding in the first 24 to 72 hours. Despite improvements in endoscopic hemostasis and pharmacological therapies , upper gastrointestinal (UGI) ulcers rebleed in 10% to 20% of patients. 3 Therefore, determining the factors involved in rebleeding after initial endoscopic hemostasis is extremely important for patients with UGIB. In addition, understanding the factors that contribute to intractable or insufficient initial endoscopic hemostasis is needed to improve the management of such ulcers. This Japanese study focused on defining the factors associated with the intractability to endoscopic hemostasis in patients with bleeding upper gastroduodenal peptic ulcers. In general, the main predictors for rebleeding after endo-scopic hemostasis were hemodynamic instability, comorbidi-ty, active bleeding, large ulcers, and exposed vessel characteristics. The risk of bleeding peptic ulcers associated with nonste-roidal anti-inflammatory drug (NSAID) use in patients with Helicobacter pylori is well-known, but the risk factors for bleeding after initial hemostasis are different. 5 Although these two main risk factors are causal factors for bleeding in patients with peptic ulcers, they cannot be the main deciding factors for rebleeding after initial hemostasis in PUB. The most important factors are endoscopic factors relating to stigmata size and location, and successful endoscopic he-mostasis using the correct hemostatic method. 6 This study shows that exposed vessels with a diameter of ≥2 mm on the predicted intractable endoscopic hemo-stasis. The diameter or the number of exposed vessels can be the risk factor determining the success of endoscopic hemo-stasis. Control of bleeding from vessels with large diameters cannot be achieved by mechanical clipping or simple thermal coagulation; endoscopists should be more careful to control stigmata. A difficult location can also be an important deciding factor for successful endoscopic hemostasis, especially mechanical hemostasis. However, thermal coagulation such as argon plasma coagulation can be a compensatory method in cases …