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Endoscopic Therapy for Peptic Ulcer Hemorrhage: Practice Variations in a Multi-Center U.S. Consortium

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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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Grant support

This project was supported with the funding from NIDDK UO1 CA 89389-01 and R33-DK61778-01. In addition, the practice network (Clinical Outcomes Research Initiative) has received support from the following entities to support the infrastructure of the practice based network: AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research.

Conflicts of interest statement

Dr. Lieberman is the executive director of CORI and Dr. Eisen is the executive co-director of CORI, a non-profit organization that receives funding from federal and industry sources. This potential conflict of interest has been reviewed and managed by the OHSU Conflict of Interest in Research Committee.

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Authors and Affiliations

  1. Division of Gastroenterology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Mail Code L-461, Portland, OR, 97239, USA

    Brintha K. Enestvedt, David A. Lieberman & Glenn M. Eisen

  2. Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland, OR, USA

    Nora Mattek

  3. The Rappaport Faculty of Medicine, Department of Gastroenterology, GI Outcomes Unit, Technion Israel Institute of Technology, Rambam Health Care Campus, Haifa, Israel

    Ian M. Gralnek

Authors
  1. Brintha K. Enestvedt
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  2. Ian M. Gralnek
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  3. Nora Mattek
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  4. David A. Lieberman
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  5. Glenn M. Eisen
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Corresponding author

Correspondence to Brintha K. Enestvedt.

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Enestvedt, B.K., Gralnek, I.M., Mattek, N. et al. Endoscopic Therapy for Peptic Ulcer Hemorrhage: Practice Variations in a Multi-Center U.S. Consortium. Dig Dis Sci 55, 2568–2576 (2010). https://doi.org/10.1007/s10620-010-1311-5

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  • DOI: https://doi.org/10.1007/s10620-010-1311-5

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