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Therapeutic decision-making in endoscopically unmanageable nonvariceal upper gastrointestinal hemorrhage

Luc Defreyne UGent, Ignace De Schrijver, Johan Decruyenaere UGent, Georges Van Maele UGent, Wim Ceelen UGent, Danny De Looze UGent and PETER VANLANGENHOVE UGent (2008) CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. 31(5). p.897-905
abstract
The purpose of this study was to identify endoscopic and clinical parameters influencing the decision-making in salvage of endoscopically unmanageable, nonvariceal upper gastrointestinal hemorrhage (UGIH) and to report the outcome of selected therapy. We retrospectively retrieved all cases of surgery and arteriography for arrest of endoscopically unmanageable UGIH. Only patients with overt bleeding on endoscopy within the previous 24 h were included. Patients with preceding nonendoscopic hemostatic interventions, portal hypertension, malignancy, and transpapillar bleeding were excluded. Potential clinical and endoscopic predictors of allocation to either surgery or arteriography were tested using statistical models. Outcome and survival were regressed on the choice of rescue and clinical variables. Forty-six arteriographed and 51 operated patients met the inclusion criteria. Univariate analysis revealed a higher number of patients with a coagulation disorder in the catheterization group (41.4%, versus 20.4% in the laparotomy group; p = 0.044). With multivariate analysis, the identification of a bleeding peptic ulcer at endoscopy significantly steered decision-making toward surgical rescue (OR = 5.2; p = 0.021). Taking into account reinterventions, hemostasis was achieved in nearly 90% of cases in both groups. Overall therapy failure (no survivors), rebleeding within 3 days (OR = 3.7; p = 0.042), and corticosteroid use (OR = 5.2; p = 0.017) had a significant negative impact on survival. The odds of dying were not different for embolotherapy or surgery. In conclusion, decision-making was endoscopy-based, with bleeding peptic ulcer significantly directing the choice of rescue toward surgery. Unsuccessful hemostasis and corticosteroid use, but not the choice of rescue, negatively affected outcome.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
journal title
CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
Cardiovasc. Interv. Radiol.
volume
31
issue
5
pages
897-905 pages
Web of Science type
Article
Web of Science id
000259186600010
JCR category
RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
JCR impact factor
1.721 (2008)
JCR rank
51/90 (2008)
JCR quartile
3 (2008)
ISSN
0174-1551
DOI
10.1007/s00270-008-9320-x
language
English
UGent publication?
yes
classification
A1
id
433504
handle
http://hdl.handle.net/1854/LU-433504
date created
2008-10-28 11:48:00
date last changed
2010-02-25 15:26:27
@article{433504,
  abstract     = {The purpose of this study was to identify endoscopic and clinical parameters influencing the decision-making in salvage of endoscopically unmanageable, nonvariceal upper gastrointestinal hemorrhage (UGIH) and to report the outcome of selected therapy. We retrospectively retrieved all cases of surgery and arteriography for arrest of endoscopically unmanageable UGIH. Only patients with overt bleeding on endoscopy within the previous 24 h were included. Patients with preceding nonendoscopic hemostatic interventions, portal hypertension, malignancy, and transpapillar bleeding were excluded. Potential clinical and endoscopic predictors of allocation to either surgery or arteriography were tested using statistical models. Outcome and survival were regressed on the choice of rescue and clinical variables. Forty-six arteriographed and 51 operated patients met the inclusion criteria. Univariate analysis revealed a higher number of patients with a coagulation disorder in the catheterization group (41.4\%, versus 20.4\% in the laparotomy group; p = 0.044). With multivariate analysis, the identification of a bleeding peptic ulcer at endoscopy significantly steered decision-making toward surgical rescue (OR = 5.2; p = 0.021). Taking into account reinterventions, hemostasis was achieved in nearly 90\% of cases in both groups. Overall therapy failure (no survivors), rebleeding within 3 days (OR = 3.7; p = 0.042), and corticosteroid use (OR = 5.2; p = 0.017) had a significant negative impact on survival. The odds of dying were not different for embolotherapy or surgery. In conclusion, decision-making was endoscopy-based, with bleeding peptic ulcer significantly directing the choice of rescue toward surgery. Unsuccessful hemostasis and corticosteroid use, but not the choice of rescue, negatively affected outcome.},
  author       = {Defreyne, Luc and De Schrijver, Ignace and Decruyenaere, Johan and Van Maele, Georges and Ceelen, Wim and De Looze, Danny and VANLANGENHOVE, PETER},
  issn         = {0174-1551},
  journal      = {CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY},
  language     = {eng},
  number       = {5},
  pages        = {897--905},
  title        = {Therapeutic decision-making in endoscopically unmanageable nonvariceal upper gastrointestinal hemorrhage},
  url          = {http://dx.doi.org/10.1007/s00270-008-9320-x},
  volume       = {31},
  year         = {2008},
}

Chicago
Defreyne, Luc, Ignace De Schrijver, Johan Decruyenaere, Georges Van Maele, Wim Ceelen, Danny De Looze, and PETER VANLANGENHOVE. 2008. “Therapeutic Decision-making in Endoscopically Unmanageable Nonvariceal Upper Gastrointestinal Hemorrhage.” Cardiovascular and Interventional Radiology 31 (5): 897–905.
APA
Defreyne, L., De Schrijver, I., Decruyenaere, J., Van Maele, G., Ceelen, W., De Looze, D., & VANLANGENHOVE, P. (2008). Therapeutic decision-making in endoscopically unmanageable nonvariceal upper gastrointestinal hemorrhage. CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 31(5), 897–905.
Vancouver
1.
Defreyne L, De Schrijver I, Decruyenaere J, Van Maele G, Ceelen W, De Looze D, et al. Therapeutic decision-making in endoscopically unmanageable nonvariceal upper gastrointestinal hemorrhage. CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. 2008;31(5):897–905.
MLA
Defreyne, Luc, Ignace De Schrijver, Johan Decruyenaere, et al. “Therapeutic Decision-making in Endoscopically Unmanageable Nonvariceal Upper Gastrointestinal Hemorrhage.” CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY 31.5 (2008): 897–905. Print.