Doppler endoscopic probe as a guide to risk stratification and definitive hemostasis of peptic ulcer bleeding

Gastrointestinal Endoscopy
Dennis M JensenG A Machicado

Abstract

For more than 4 decades endoscopists have relied on ulcer stigmata for risk stratification and as a guide to hemostasis. None used arterial blood flow underneath stigmata to predict outcomes. For patients with severe peptic ulcer bleeding (PUB), we used a Doppler endoscopic probe (DEP) for (1) detection of blood flow underlying stigmata of recent hemorrhage (SRH), (2) quantitating rates of residual arterial blood flow under SRH after visually directed standard endoscopic treatment, and (3) comparing risks of rebleeding and actual 30-day rebleed rates for spurting arterial bleeding (Forrest [F] IA) and oozing bleeding (F IB). Prospective cohort study of 163 consecutive patients with severe PUB and different SRH. All blood flow detected by the DEP was arterial. Detection rates were 87.4% in major SRH-spurting arterial bleeding (F IA), non-bleeding visible vessel (F IIA), clot (F IIB)-and were significantly lower at 42.3% (P < .0001) for an intermediate group of oozing bleeding (F IB) or flat spot (F IIC). For spurting bleeding (F IA) versus oozing (F IB), baseline DEP arterial flow was 100% versus 46.7%, residual blood flow detected after endoscopic hemostasis was 35.7% versus 0%, and 30-day rebleed rates were 28.6% versus 0% (al...Continue Reading

References

Oct 15, 1981·The New England Journal of Medicine·D W StoreyT C Northfield
Sep 15, 1994·The New England Journal of Medicine·L Laine, W L Peterson
Nov 24, 2004·Gastrointestinal Endoscopy·Richard C K Wong
Aug 30, 2008·The New England Journal of Medicine·Ian M GralnekMarc Bardou
Feb 18, 2009·Annals of Internal Medicine·Joseph J Y SungUNKNOWN Peptic Ulcer Bleed Study Group
Apr 8, 2011·Gut·Joseph J Y SungUNKNOWN Asia-Pacific Working Group

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Citations

Jan 10, 2016·Digestive Diseases and Sciences·Jonathan D Kaunitz
Dec 27, 2015·Gastrointestinal Endoscopy·Jennifer Nayor, John R Saltzman
Jan 18, 2017·The American Journal of Gastroenterology·Dennis M JensenTore Lind
Jun 26, 2017·Gastroenterology·Michael B WallaceAmit Rastogi
Nov 6, 2018·Scandinavian Journal of Gastroenterology·Marcus KantowskiCarsten Schmidt
Oct 19, 2017·F1000Research·Ian Beales
Apr 5, 2017·Current Gastroenterology Reports·Kevin A Ghassemi, Dennis M Jensen
Apr 20, 2018·Nature Reviews. Disease Primers·Angel LanasJoseph J Y Sung
Sep 17, 2019·World Journal of Gastrointestinal Endoscopy·F Paul BuckleyAmarpreet Chawla
Jan 11, 2020·World Journal of Emergency Surgery : WJES·Antonio TarasconiFausto Catena
Aug 24, 2020·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Dennis M JensenJeffrey Gornbein
Jan 20, 2021·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Dennis M Jensen
Feb 17, 2021·Digestive Diseases and Sciences·Peerapol WangrattanapraneeMary Ellen Jensen
Jun 10, 2021·Digestive Diseases and Sciences·B Nulsen, D M Jensen
Jul 22, 2021·Alimentary Pharmacology & Therapeutics·Dennis M JensenJoseph J Y Sung
Jul 25, 2021·Journal of Clinical Medicine·Pablo Cañamares-Orbís, Ángel Lanas Arbeloa
Aug 7, 2017·Gastroenterology·Dennis M Jensen

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