Role of Doppler US in acute peptic ulcer hemorrhage: Can it predict failure of endoscopic therapy?
Background: Recurrent bleeding after successful primary endoscopic hemostasis of acutely bleeding ulcers is a significant problem.This study evaluates endoscopic Doppler ultrasound (US) in assessing risk of recurrent bleeding in patients presenting with acute peptic ulcer hemorrhage. Methods: In thi...
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Published in | Gastrointestinal endoscopy Vol. 52; no. 3; pp. 315 - 321 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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New York, NY
Mosby, Inc
01.09.2000
Elsevier |
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Abstract | Background: Recurrent bleeding after successful primary endoscopic hemostasis of acutely bleeding ulcers is a significant problem.This study evaluates endoscopic Doppler ultrasound (US) in assessing risk of recurrent bleeding in patients presenting with acute peptic ulcer hemorrhage. Methods: In this prospective, double-blind, nonrandomized trial, patients were enrolled from a single academic institution. Only patients with endoscopically confirmed gastric, duodenal, pyloric, or anastomotic ulcers were enrolled. The therapeutic endoscopist was blinded to the Doppler US signal from the ulcer and based treatment decisions on standard guidelines. A 16 MHz pulsed-wave, linear scanning, US probe was used through the accessory channel of an endoscope to assess for the presence of a Doppler signal. Results: Fifty-two of 139 screened patients entered the trial (55 Doppler sessions). Endoscopic therapy was performed in 42% (30-day recurrent bleeding rate of 17%). Ulcers that remained persistently Doppler positive immediately after endoscopic therapy had a significantly higher rate of recurrent bleeding than ulcers where the Doppler signal was abolished: 100% versus 11% (p = 0.003). There were no bleeding-related deaths. Conclusions: A persistently positive Doppler US signal appears to be a marker of inadequate endoscopic therapy in patients with acutely bleeding peptic ulcers. (Gastrointest Endosc 2000;52:315–21.) |
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AbstractList | Background: Recurrent bleeding after successful primary endoscopic hemostasis of acutely bleeding ulcers is a significant problem.This study evaluates endoscopic Doppler ultrasound (US) in assessing risk of recurrent bleeding in patients presenting with acute peptic ulcer hemorrhage. Methods: In this prospective, double-blind, nonrandomized trial, patients were enrolled from a single academic institution. Only patients with endoscopically confirmed gastric, duodenal, pyloric, or anastomotic ulcers were enrolled. The therapeutic endoscopist was blinded to the Doppler US signal from the ulcer and based treatment decisions on standard guidelines. A 16 MHz pulsed-wave, linear scanning, US probe was used through the accessory channel of an endoscope to assess for the presence of a Doppler signal. Results: Fifty-two of 139 screened patients entered the trial (55 Doppler sessions). Endoscopic therapy was performed in 42% (30-day recurrent bleeding rate of 17%). Ulcers that remained persistently Doppler positive immediately after endoscopic therapy had a significantly higher rate of recurrent bleeding than ulcers where the Doppler signal was abolished: 100% versus 11% (p = 0.003). There were no bleeding-related deaths. Conclusions: A persistently positive Doppler US signal appears to be a marker of inadequate endoscopic therapy in patients with acutely bleeding peptic ulcers. (Gastrointest Endosc 2000;52:315–21.) BACKGROUNDRecurrent bleeding after successful primary endoscopic hemostasis of acutely bleeding ulcers is a significant problem. This study evaluates endoscopic Doppler ultrasound (US) in assessing risk of recurrent bleeding in patients presenting with acute peptic ulcer hemorrhage.METHODSIn this prospective, double-blind, nonrandomized trial, patients were enrolled from a single academic institution. Only patients with endoscopically confirmed gastric, duodenal, pyloric, or anastomotic ulcers were enrolled. The therapeutic endoscopist was blinded to the Doppler US signal from the ulcer and based treatment decisions on standard guidelines. A 16 MHz pulsed-wave, linear scanning, US probe was used through the accessory channel of an endoscope to assess for the presence of a Doppler signal.RESULTSFifty-two of 139 screened patients entered the trial (55 Doppler sessions). Endoscopic therapy was performed in 42% (30-day recurrent bleeding rate of 17%). Ulcers that remained persistently Doppler positive immediately after endoscopic therapy had a significantly higher rate of recurrent bleeding than ulcers where the Doppler signal was abolished: 100% versus 11% (p = 0.003). There were no bleeding-related deaths.CONCLUSIONSA persistently positive Doppler US signal appears to be a marker of inadequate endoscopic therapy in patients with acutely bleeding peptic ulcers. Recurrent bleeding after successful primary endoscopic hemostasis of acutely bleeding ulcers is a significant problem. This study evaluates endoscopic Doppler ultrasound (US) in assessing risk of recurrent bleeding in patients presenting with acute peptic ulcer hemorrhage. In this prospective, double-blind, nonrandomized trial, patients were enrolled from a single academic institution. Only patients with endoscopically confirmed gastric, duodenal, pyloric, or anastomotic ulcers were enrolled. The therapeutic endoscopist was blinded to the Doppler US signal from the ulcer and based treatment decisions on standard guidelines. A 16 MHz pulsed-wave, linear scanning, US probe was used through the accessory channel of an endoscope to assess for the presence of a Doppler signal. Fifty-two of 139 screened patients entered the trial (55 Doppler sessions). Endoscopic therapy was performed in 42% (30-day recurrent bleeding rate of 17%). Ulcers that remained persistently Doppler positive immediately after endoscopic therapy had a significantly higher rate of recurrent bleeding than ulcers where the Doppler signal was abolished: 100% versus 11% (p = 0.003). There were no bleeding-related deaths. A persistently positive Doppler US signal appears to be a marker of inadequate endoscopic therapy in patients with acutely bleeding peptic ulcers. |
Author | Cooper, Gregory S. Carr-Locke, David L. Chak, Amitabh Kobayashi, Kenji Wong, Richard C.K. Isenberg, Gerard A. Sivak, Michael V. |
Author_xml | – sequence: 1 givenname: Richard C.K. surname: Wong fullname: Wong, Richard C.K. – sequence: 2 givenname: Amitabh surname: Chak fullname: Chak, Amitabh – sequence: 3 givenname: Kenji surname: Kobayashi fullname: Kobayashi, Kenji – sequence: 4 givenname: Gerard A. surname: Isenberg fullname: Isenberg, Gerard A. – sequence: 5 givenname: Gregory S. surname: Cooper fullname: Cooper, Gregory S. – sequence: 6 givenname: David L. surname: Carr-Locke fullname: Carr-Locke, David L. – sequence: 7 givenname: Michael V. surname: Sivak fullname: Sivak, Michael V. |
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Keywords | Sonography Doppler ultrasound study Human Postoperative Relapse Acute Cardiovascular disease Gastrointestinal Hemorrhage Vascular disease Gastroduodenal Double blind study Digestive diseases Intestinal disease Complication Clinical trial Ulcer Predictive factor Gastric disease |
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References | Lau, Sung, Chan, Lai, Lau, Ng (bib1) 1997; 46 Ell, German Ulcer Bleeding Study Group (bib16) 1998; 47 Laine (bib10) 1990; 99 Steele, Park, Crofts (bib14) 1991; 78 Kohler, Maier, Benz, Riemann (bib2) 1997; 42 Chung, Lau, Sung, Chan, Lai, Ng (bib11) 1997; 314 Consensus Development Panel (bib7) 1990; 36 Kohler, Riemann (bib4) 1991; 26 Consensus Conference (bib6) 1989; 262 Wong, Lau, Suen, Lam, Chan, Chung (bib18) 1999; 49 Rockall, Logan, Devlin, Northfield (bib12) 1996; 38 Chung, Leung, Sung, Lo, Li (bib8) 1991; 100 Chung, Leung, Steele, Crofts, Li (bib13) 1988; 296 Villanueva, Balanzo, Torras, Soriano, Sainz, Vilardell (bib15) 1994; 40 Waring, Sanowski, Sawyer, Woods, Foutch (bib9) 1991; 37 Kohler, Riemann (bib3) 1993; 25 Saeed, Cole, Ramirez, Schneider, Hepps, Graham (bib17) 1996; 28 Laine, Peterson (bib5) 1994; 331 10968873 - Gastrointest Endosc. 2000 Sep;52(3):438-40 Chung (10.1067/mge.2000.106688_bib11) 1997; 314 Lau (10.1067/mge.2000.106688_bib1) 1997; 46 Chung (10.1067/mge.2000.106688_bib13) 1988; 296 Kohler (10.1067/mge.2000.106688_bib2) 1997; 42 Ell (10.1067/mge.2000.106688_bib16) 1998; 47 Saeed (10.1067/mge.2000.106688_bib17) 1996; 28 Kohler (10.1067/mge.2000.106688_bib3) 1993; 25 Villanueva (10.1067/mge.2000.106688_bib15) 1994; 40 Consensus Conference (10.1067/mge.2000.106688_bib6) 1989; 262 Waring (10.1067/mge.2000.106688_bib9) 1991; 37 Rockall (10.1067/mge.2000.106688_bib12) 1996; 38 Wong (10.1067/mge.2000.106688_bib18) 1999; 49 Consensus Development Panel (10.1067/mge.2000.106688_bib7) 1990; 36 Laine (10.1067/mge.2000.106688_bib10) 1990; 99 Laine (10.1067/mge.2000.106688_bib5) 1994; 331 Steele (10.1067/mge.2000.106688_bib14) 1991; 78 Chung (10.1067/mge.2000.106688_bib8) 1991; 100 Kohler (10.1067/mge.2000.106688_bib4) 1991; 26 |
References_xml | – volume: 28 start-page: 288 year: 1996 end-page: 294 ident: bib17 article-title: Endoscopic retreatment after successful initial hemostasis prevents ulcer rebleeding: a prospective randomized trial publication-title: Endoscopy contributor: fullname: Graham – volume: 40 start-page: 34 year: 1994 end-page: 39 ident: bib15 article-title: Value of second-look endoscopy after injection therapy for bleeding peptic ulcer: a prospective and randomized trial publication-title: Gastrointest Endosc contributor: fullname: Vilardell – volume: 26 start-page: 471 year: 1991 end-page: 476 ident: bib4 article-title: The endoscopic Doppler: its value in evaluating gastroduodenal ulcers after hemorrhage and as an instrument of control of endoscopic injection therapy publication-title: Scand J Gastroenterol contributor: fullname: Riemann – volume: 25 start-page: 219 year: 1993 end-page: 223 ident: bib3 article-title: Endoscopic injection therapy of Forrest II and III gastroduodenal ulcers guided by endoscopic Doppler US publication-title: Endoscopy contributor: fullname: Riemann – volume: 49 start-page: AB170 year: 1999 ident: bib18 article-title: Prediction of therapeutic failure with epinephrine injection and heat probe treatment in bleeding peptic ulcer [abstract] publication-title: Gastrointest Endosc contributor: fullname: Chung – volume: 100 start-page: 33 year: 1991 end-page: 37 ident: bib8 article-title: Injection or heat probe for bleeding ulcer publication-title: Gastroenterology contributor: fullname: Li – volume: 42 start-page: 1370 year: 1997 end-page: 1374 ident: bib2 article-title: Acute ulcer bleeding: a prospective randomized trial to compare Doppler and Forrest classifications in endoscopic diagnosis and therapy publication-title: Dig Dis Sci contributor: fullname: Riemann – volume: 99 start-page: 1303 year: 1990 end-page: 1306 ident: bib10 article-title: Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers. A prospective, randomized trial publication-title: Gastroenterology contributor: fullname: Laine – volume: 38 start-page: 316 year: 1996 end-page: 321 ident: bib12 article-title: Risk assessment after acute upper gastrointestinal haemorrhage publication-title: Gut contributor: fullname: Northfield – volume: 314 start-page: 1307 year: 1997 end-page: 1311 ident: bib11 article-title: Randomized comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers publication-title: BMJ contributor: fullname: Ng – volume: 296 start-page: 1631 year: 1988 end-page: 1633 ident: bib13 article-title: Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial publication-title: BMJ contributor: fullname: Li – volume: 46 start-page: 33 year: 1997 end-page: 36 ident: bib1 article-title: Stigmata of hemorrhage in bleeding peptic ulcers: an interobserver agreement study among international experts publication-title: Gastrointest Endosc contributor: fullname: Ng – volume: 331 start-page: 717 year: 1994 end-page: 727 ident: bib5 article-title: Bleeding peptic ulcer publication-title: N Engl J Med contributor: fullname: Peterson – volume: 36 start-page: S62 year: 1990 end-page: S65 ident: bib7 article-title: Consensus statement on therapeutic endoscopy and bleeding ulcers publication-title: Gastrointest Endosc contributor: fullname: Consensus Development Panel – volume: 262 start-page: 1369 year: 1989 end-page: 1372 ident: bib6 article-title: Therapeutic endoscopy and bleeding ulcers publication-title: JAMA contributor: fullname: Consensus Conference – volume: 47 start-page: AB83 year: 1998 ident: bib16 article-title: Scheduled endoscopic re-treatment vs. single injection therapy in bleeding gastroduodenal ulcers: results of a multicenter study [abstract] publication-title: Gastrointest Endosc contributor: fullname: German Ulcer Bleeding Study Group – volume: 37 start-page: 295 year: 1991 end-page: 298 ident: bib9 article-title: A randomized comparison of multipolar electrocoagulation and injection sclerosis for the treatment of bleeding peptic ulcer publication-title: Gastrointest Endosc contributor: fullname: Foutch – volume: 78 start-page: 477 year: 1991 end-page: 479 ident: bib14 article-title: Adrenaline injection for endoscopic haemostasis in non-variceal upper gastrointestinal haemorrhage publication-title: Br J Surg contributor: fullname: Crofts – volume: 99 start-page: 1303 year: 1990 ident: 10.1067/mge.2000.106688_bib10 article-title: Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers. A prospective, randomized trial publication-title: Gastroenterology doi: 10.1016/0016-5085(90)91154-X contributor: fullname: Laine – volume: 37 start-page: 295 year: 1991 ident: 10.1067/mge.2000.106688_bib9 article-title: A randomized comparison of multipolar electrocoagulation and injection sclerosis for the treatment of bleeding peptic ulcer publication-title: Gastrointest Endosc doi: 10.1016/S0016-5107(91)70718-9 contributor: fullname: Waring – volume: 36 start-page: S62 year: 1990 ident: 10.1067/mge.2000.106688_bib7 article-title: Consensus statement on therapeutic endoscopy and bleeding ulcers publication-title: Gastrointest Endosc contributor: fullname: Consensus Development Panel – volume: 40 start-page: 34 year: 1994 ident: 10.1067/mge.2000.106688_bib15 article-title: Value of second-look endoscopy after injection therapy for bleeding peptic ulcer: a prospective and randomized trial publication-title: Gastrointest Endosc doi: 10.1016/S0016-5107(94)70006-0 contributor: fullname: Villanueva – volume: 78 start-page: 477 year: 1991 ident: 10.1067/mge.2000.106688_bib14 article-title: Adrenaline injection for endoscopic haemostasis in non-variceal upper gastrointestinal haemorrhage publication-title: Br J Surg doi: 10.1002/bjs.1800780428 contributor: fullname: Steele – volume: 100 start-page: 33 year: 1991 ident: 10.1067/mge.2000.106688_bib8 article-title: Injection or heat probe for bleeding ulcer publication-title: Gastroenterology doi: 10.1016/0016-5085(91)90579-A contributor: fullname: Chung – volume: 314 start-page: 1307 year: 1997 ident: 10.1067/mge.2000.106688_bib11 article-title: Randomized comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers publication-title: BMJ doi: 10.1136/bmj.314.7090.1307 contributor: fullname: Chung – volume: 28 start-page: 288 year: 1996 ident: 10.1067/mge.2000.106688_bib17 article-title: Endoscopic retreatment after successful initial hemostasis prevents ulcer rebleeding: a prospective randomized trial publication-title: Endoscopy doi: 10.1055/s-2007-1005455 contributor: fullname: Saeed – volume: 25 start-page: 219 year: 1993 ident: 10.1067/mge.2000.106688_bib3 article-title: Endoscopic injection therapy of Forrest II and III gastroduodenal ulcers guided by endoscopic Doppler US publication-title: Endoscopy doi: 10.1055/s-2007-1010296 contributor: fullname: Kohler – volume: 262 start-page: 1369 year: 1989 ident: 10.1067/mge.2000.106688_bib6 article-title: Therapeutic endoscopy and bleeding ulcers publication-title: JAMA doi: 10.1001/jama.1989.03430100103037 contributor: fullname: Consensus Conference – volume: 26 start-page: 471 year: 1991 ident: 10.1067/mge.2000.106688_bib4 article-title: The endoscopic Doppler: its value in evaluating gastroduodenal ulcers after hemorrhage and as an instrument of control of endoscopic injection therapy publication-title: Scand J Gastroenterol doi: 10.3109/00365529108998568 contributor: fullname: Kohler – volume: 296 start-page: 1631 year: 1988 ident: 10.1067/mge.2000.106688_bib13 article-title: Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial publication-title: BMJ doi: 10.1136/bmj.296.6637.1631 contributor: fullname: Chung – volume: 47 start-page: AB83 year: 1998 ident: 10.1067/mge.2000.106688_bib16 article-title: Scheduled endoscopic re-treatment vs. single injection therapy in bleeding gastroduodenal ulcers: results of a multicenter study [abstract] publication-title: Gastrointest Endosc contributor: fullname: Ell – volume: 46 start-page: 33 year: 1997 ident: 10.1067/mge.2000.106688_bib1 article-title: Stigmata of hemorrhage in bleeding peptic ulcers: an interobserver agreement study among international experts publication-title: Gastrointest Endosc doi: 10.1016/S0016-5107(97)70206-2 contributor: fullname: Lau – volume: 331 start-page: 717 year: 1994 ident: 10.1067/mge.2000.106688_bib5 article-title: Bleeding peptic ulcer publication-title: N Engl J Med doi: 10.1056/NEJM199409153311107 contributor: fullname: Laine – volume: 49 start-page: AB170 year: 1999 ident: 10.1067/mge.2000.106688_bib18 article-title: Prediction of therapeutic failure with epinephrine injection and heat probe treatment in bleeding peptic ulcer [abstract] publication-title: Gastrointest Endosc contributor: fullname: Wong – volume: 42 start-page: 1370 year: 1997 ident: 10.1067/mge.2000.106688_bib2 article-title: Acute ulcer bleeding: a prospective randomized trial to compare Doppler and Forrest classifications in endoscopic diagnosis and therapy publication-title: Dig Dis Sci doi: 10.1023/A:1018877602113 contributor: fullname: Kohler – volume: 38 start-page: 316 year: 1996 ident: 10.1067/mge.2000.106688_bib12 article-title: Risk assessment after acute upper gastrointestinal haemorrhage publication-title: Gut doi: 10.1136/gut.38.3.316 contributor: fullname: Rockall |
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Snippet | Background: Recurrent bleeding after successful primary endoscopic hemostasis of acutely bleeding ulcers is a significant problem.This study evaluates... Recurrent bleeding after successful primary endoscopic hemostasis of acutely bleeding ulcers is a significant problem. This study evaluates endoscopic Doppler... BACKGROUNDRecurrent bleeding after successful primary endoscopic hemostasis of acutely bleeding ulcers is a significant problem. This study evaluates... |
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SubjectTerms | Acute Disease Aged Biological and medical sciences Digestive system. Abdomen Double-Blind Method Duodenal Ulcer - diagnostic imaging Duodenal Ulcer - pathology Duodenal Ulcer - therapy Endoscopy, Digestive System Endosonography Female Hemostasis, Endoscopic Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Observer Variation Peptic Ulcer Hemorrhage - diagnostic imaging Peptic Ulcer Hemorrhage - pathology Peptic Ulcer Hemorrhage - therapy Prognosis Prospective Studies Recurrence Stomach Ulcer - diagnostic imaging Stomach Ulcer - pathology Stomach Ulcer - therapy Treatment Failure Ultrasonic investigative techniques Ultrasonography, Doppler, Pulsed - methods |
Title | Role of Doppler US in acute peptic ulcer hemorrhage: Can it predict failure of endoscopic therapy? |
URI | https://dx.doi.org/10.1067/mge.2000.106688 https://www.ncbi.nlm.nih.gov/pubmed/10968843 https://search.proquest.com/docview/72222576 |
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