혈괴가 부착된 소화성 궤양 출혈 환자에서 내시경 지혈 치료와 양성자 펌프 억제 약물치료의 효과 비교: 다기관 전향적 관찰상 코호트 연구
- Other Titles
- Comparison between Endoscopic Therapy and Medical Therapy in Peptic Ulcer Patients with Adherent Clot: A Multicenter Prospective Observational Cohort Study
- 김시혜; 정진태; 권중구; 전성우; 박경식; 이시형; 박정배; 하창윤; 박윤선; 김은영; 이동욱
- Dept. of Internal Medicine (내과학)
- Issue Date
- Korean Journal of Gastroenterology, Vol.66(2) : 98-105, 2015
- Background/Aims: The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose
of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk
factors of rebleeding in Forrest type IIB peptic ulcer.
Methods: Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December
2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic
ulcer with adherent clots were enrolled.
Results: Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as
Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were
managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher
Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs.
10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group.
However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641).
In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1;
Conclusions: In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction
in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding
was use of aspirin and/or NSAID.
- Peptic ulcer; Bleeding; Mortality; Risk factors
- Appears in Collections:
- 1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
- Keimyung Author(s)
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