초록 열기/닫기 버튼
Background/Aims: Despite improvements in endoscopic hemostasis and pharmacological therapies, upper gastrointestinal (UGI) ulcersrepeatedly bleed in 10% to 20% of patients, and those without early endoscopic reintervention or definitive surgery might be at ahigh risk for mortality. This study aimed to identify the risk factors for intractability to initial endoscopic hemostasis. Methods: We analyzed intractability among 428 patients who underwent emergency endoscopy for bleeding UGI ulcers within 24hours of arrival at the hospital. Results: Durable hemostasis was achieved in 354 patients by using initial endoscopic procedures. Sixty-nine patients with Forrest typesIa, Ib, IIa, and IIb at the second-look endoscopy were considered intractable to the initial endoscopic hemostasis. Multivariate analysisindicated that age ≥70 years (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.07 to 4.03), shock on admission (OR, 5.26; 95% CI,2.43 to 11.6), hemoglobin <8.0 mg/dL (OR, 2.80; 95% CI, 1.39 to 5.91), serum albumin <3.3 g/dL (OR, 2.23; 95% CI, 1.07 to 4.89), exposedvessels with a diameter of ≥2 mm on the bottom of ulcers (OR, 4.38; 95% CI, 1.25 to 7.01), and Forrest type Ia and Ib (OR, 2.21;95% CI, 1.33 to 3.00) predicted intractable endoscopic hemostasis. Conclusions: Various factors contribute to intractable endoscopic hemostasis. Careful observation after endoscopic hemostasis is importantfor patients at a high risk for incomplete hemostasis.
