Endoscopic treatment modalities and outcomes in nonvariceal upper gastrointestinal bleeding

Benjamin Cherng Hann Yip; Hossain Sayeed Sajjad; Jie-Xun Wang; Constantinos P Anastassiades

doi:10.4253/wjge.v12.i2.72

Endoscopic treatment modalities and outcomes in nonvariceal upper gastrointestinal bleeding

World J Gastrointest Endosc. 2020 Feb 16;12(2):72-82. doi: 10.4253/wjge.v12.i2.72.

Authors

Benjamin Cherng Hann Yip¹, Hossain Sayeed Sajjad², Jie-Xun Wang³, Constantinos P Anastassiades⁴

Affiliations

¹ Department of General Medicine, Khoo Teck Puat Hospital, Singapore 768828, Singapore. yip.benjamin.ch@ktph.com.sg.
² Department of Acute Medicine, Northampton General Hospital, Cliftonville, Northampton NN1 5BD, United Kingdom.
³ Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Singapore.
⁴ Department of General Medicine, Khoo Teck Puat Hospital, Singapore 768828, Singapore.

Abstract

Background: In nonvariceal upper gastrointestinal bleeding (NVUGIB), the optimal volume of adrenaline, the optimal number of hemoclips, and the application of thermal coagulation in determining patient outcomes have not been well studied.

Aim: To demonstrate a dose-response relationship between the commonly used endoscopic modalities for the treatment of non-variceal upper gastrointestinal bleeding and various clinical outcomes.

Methods: Patients presenting with NVUGIB were retrospectively identified and analyzed. These patients were stratified as follows: (1) > 10 mL of adrenaline injected vs ≤ 10 mL; (2) > 1 hemoclip placed vs ≤ 1 hemoclip; (3) Heater probe used or not; and (4) > 2 treatment modalities used vs ≤ 2. The primary outcomes were rebleeding and the need for repeat endoscopy. The secondary outcomes were the need for surgery, required transfusions, length of hospital stay, death during the same admission period and 30 d mortality. Patients with NVUGIB who required endoscopic therapy were included. Those who did not require endoscopic therapy or were initially treated with surgery or embolization were excluded.

Results: In all, 501 patients with NVUGIB were treated. One hundred sixty-one (32.1%) patients needed endoscopic therapy. The injection of < 10 mL of adrenaline was associated with less rebleeding (P < 0.0001), the need for repeat endoscopy (P = 0.001) and a decreased length of hospital stay (P = 0.026). The use of > 2 treatment modalities were associated with increased rebleeding (P = 0.009) and the need for repeat endoscopy (P = 0.048). The placement of > 1 hemoclip was associated with a decreased length of hospital stay (P = 0.044). The rates of surgery and death were low, and there were no other significant differences between the patient groups.

Conclusion: The more restrictive use of adrenaline and number of endoscopic modalities to treat NVUGIB with the more liberal use of hemoclips was associated with better patient outcomes.

Keywords: Nonvariceal upper gastrointestinal bleeding; Outcome predictors.