Factors contributing to the failure of argon plasma coagulation hemostasis in patients with nonvariceal upper gastrointestinal tract bleeding.

BACKGROUND/AIMS: Among endoscopic therapies, injection methods, thermal coagulation and mechanical devices are the major therapeutic modalities for upper gastrointestinal bleeding. Argon plasma coagulation (APC), non-contact electrocoagulation, is a procedure which involves thermal coagulation of tissue. In this study, our aim was to clarify the factors associated with APC treatment failure in patients with non-variceal gastrointestinal bleeding. METHODS: We followed up 58 non-variceal upper GI bleeding patients who received endoscopic treatment in our emergency department with APC to control bleeding from November 2006 to March 2008. Patients who received APC hemostasis were followed up to check for evidence of rebleeding by clinical symptoms and signs or drops of hemoglobulin during admission or after discharge. Rebleeding was defined as bleeding from the same lesions detected by repeat endoscopy. RESULTS: There were no significant differences between non-rebleeding and rebleeding patients in gender, age, presentation, initial systolic blood pressure, diastolic pressure, heart rate, hemoglobulin (pre-endoscopic and post-endoscopic treatment), BUN, creatinin or albumin. Patients with rebleeding had a lower platelet count than those withoutrebleeding(253.78 +/- 90.80 vs. 135.25 +/- 69.06, p = 0.020). In addition, patients with rebleeding had more comorbid disease (24/54 (44.4%) vs. 4/4 (100%), cirrhosis (3/54 (5.6%) vs. 3/4(75%), p = 0.002) and shock (4/54 (7.4%) and 2/4(50%) than those without rebleeding. There were no significant differences between non-rebleeding and rebleeding patients in ulcer size, location of ulcer, Forrest classification, blood transfusion, mean length of hospital stay, surgery or mortality. CONCLUSIONS: APC is an effective endoscopic therapy for non-variceal gastrointestinal bleeding. The presence of shock, low platelet count and cirrhosis may be associated with treatment failure of APC in non-variceal bleeding.

Factors associated with failure of initial endoscopic hemoclip hemostasis for upper gastrointestinal bleeding.

BACKGROUND: Endoscopic hemoclip is widely used for the management of bleeding peptic ulcers. The major difficulty in clinical application of the hemoclip is deployment to the lesion during initial hemostasis. The aim of this study was to define factors associated with the failure of endoscopic hemoclip for initial hemostasis of upper GI bleeding. PATIENTS AND METHODS: From January to December 2003, we prospectively studied 77 randomized patients with clinical evidence of upper GI bleeding due to either active bleeding or a visible vessel identified by upper GI endoscopy in our emergency department. RESULTS: Among the 77 patients, 13 (16.9%) failed treatment (Group 1) and 64 (83.1%) were successfully (Group 2) treated by endoscopic hemoclip for lesions related to upper GI bleeding. There were no differences due to gender, blood pressure, initial heart rate, and hemoglobulin before or after endoscopic treatment, platelet count, serum creatinine, and albumin between groups. The mean age of Group 1 was higher than that of Group 2 (73.31+/-9.38 years vs. 65.41+/-16.45 years, respectively; P=0.083). Most patients who did not achieve initial hemostasis by endoscopic hemoclip had upper GI lesions over the gastric antrum and duodenal bulb. Among the 13 patients who failed to achieve endoscopic hemoclip initial hemostasis, four lesions were located over the posterior wall of the antrum, and four lesions over the lesser curvature side of the duodenal bulb. CONCLUSION: Endoscopic hemoclip is an effective hemostatic method for upper GI bleeding. Age, gastric antrum, and duodenal bulb lesions may be associated with the failure of initial hemostasis by endoscopic hemoclip.