Background and study aims:In a previous study we demonstrated the efficacy of second-look endoscopy with therapy within 16-24 hours after index endoscopy in reducing major recurrent peptic ulcer bleeding.In this study,we sought to identify factors that might predict further rebleeding after this scheduled second-look endoscopy.Patients and methods:We studied 249 patients(181 men,68 women) with acute bleeding peptic ulcers who were treated at the United Christian Hospital,Hong Kong from 1999 to 2002 and who underwent a scheduled second endoscopy.Those patients who developed rebleeding after the second endoscopy were evaluated,and possible predictive factors for rebleeding were analyzed using a logistic regression model.Results:Of the 249 patients who underwent scheduled second-look endoscopy,17 patients(6.8%) developed rebleeding:seven of these patientswere treated by another endoscopic therapy;ten patients required surgery.The overall mortality rate was 3.1%.A logistic regression analysis performed on the possible predictive factors for rebleeding found that the following factors were associated with a significant risk of further rebleeding after scheduled second endoscopy:American Society of Anesthesiologists(ASA) grade III or grade IV status(odds ratio 3.81,95% CI 1.27-11.44) ,ulcer size greater than 1.0 cm(odds ratio 4.69,95% CI 1.60-13.80) ,and a finding of persistent stigmata of recent hemorrhage at the scheduled second endoscopy(odds ratio 6.65,95% CI 2.11-20.98) .Conclusions:Endoscopic factors,including large ulcer size and the persistence of endoscopic stigmata of recent hemorrhage are important predictors for recurrent bleeding after scheduled second endoscopy.
展开▼
