Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer

Abstract

Background - Although endoscopic injection therapy is effective in controlling initial haemorrhage from peptic ulcer, between 10% to 30% of patients suffer rebleeding. Aim - To assess the factors that may predict the failure of endoscopic injection in patients bleeding from high risk gastric ulcer. Subjects - One hundred and seventy eight patients admitted for a gastric ulcer with a bleeding or a non-bleeding visible vessel were included. Methods - Patients received endoscopic therapy by injection for adrenaline and polidocanol. Twelve clinical and endoscopic variables were entered into a multivariate logistic regression model to ascertain their significance as predictive factor of therapeutic failure. Results - Eighty seven per cent (155 of 178) of patients had no further bleeding after endoscopic therapy. Endoscopic injection failed in 23 (13%) patients: 20 (12%) continued to bleed or rebleed, and three (1%) patients could not be treated because of inaccessibility of the lesion. Logistic regression analysis showed that therapeutic failure was significantly related to: (1) the presence of hypovolaemic shock (p=0.09, OR 2.38, 95% CI: 0.86, 6.56), (2) the presence of active bleeding at endoscopy (p=0.02, OR 2.98, 95% CI: 1.12, 7.91), (3) ulcer location high on the lesser curvature (p=0.04, OR 2.79, 95% CI: 1.01, 7.69), and (4) ulcer size larger than 2 cm (p=0.01, OR 3.64, 95% CI: 1.34, 9.89). Conclusion - These variables may enable identification of those patients bleeding from gastric ulcer who would not benefit from injection therapy.