Elmunzer et al performed a systematic review of studies on rebleeding from a peptic ulcer after endoscopic hemostatic therapy. These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Michigan, Ohio State University, University of California San Francisco, University of Southern California and the Veterans Administration Medical Center in Ann Arbor.
Patient selection: bleeding peptic ulcer with endoscopic hemostatic therapy
Independent risk factors for rebleeding:
(1) active bleeding at time of endoscopy (Forrest IA or IB)
(2) large ulcer size (defined as >= 2 cm in 4 studies, > 1 cm in 1 study)
(3) location of ulcer on the posterior duodenal wall
(4) location of the ulcer on the lesser gastric curvature
A patient with risk factors may benefit from a second-look endoscopy and more aggressive post-endoscopic management.
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