Villanueva et al identified risk factors for therapeutic failure following endoscopic injection of a bleeding peptic ulcer. These can help to identify a patient who may benefit from more aggressive management. The authors are from Hospital de la Santa Creu i Sant Pau and Universitat Autonoma in Barcelona, Spain.
Patient selection: bleeding peptic ulcer treated by endoscopic injection
Criteria for therapeutic failure - one of the following:
(1) active bleeding seen at repeat endoscopy
(2) (vomiting of fresh blood OR bloody aspirate from nasogastric tube OR passage of fresh melena) AND (clinical hypovolemia OR falling hematocrit requiring blood transfusion)
Risk factors for therapeutic failure:
(1) ulcer located on the posterior or superior wall of the duodenal bulb
(2) ulcer diameter > 1 cm
(3) presence of one or more significant comorbid conditions
The risk of therapeutic failure increases with the number of risk factors present.
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