Prediction of Rebleeding in Peptic Ulcers by Visual Stigmata and Endoscopic Doppler Ultrasound Criteria

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Abstract
Following peptic ulcer hemorrhage, the ability to accurately determine those patients at highest risk of rebleeding relies on clinical and endoscopic criteria which are accurate in only a variable proportion of cases. In this study we have assessed prediction of rebleeding in peptic ulcers using a transendoscopic vascular detector (TVD) to compare the presence of a positive Doppler signal in relation to an ulcer base with visual stigmata of recent hemorrhage (SRH). Of 711 patients endoscoped for upper GI hemorrhage over an 18-month period 180 (25 %) were found to have a peptic ulcer. One hundred and twenty-four had either minor or no SRH at the time of endoscopy, and none of these patients rebled. Fifty-six patients had a single peptic ulcer with either active hemorrhage, a visible vessel or adherent clot, and 22 were entered into the trial. Overall, 9 patients (41 %) in this group rebled. Considering prediction of rebleeding, visible vessels had a sensitivity of 89 % and specificity of 92 % compared with a positive Doppler signal sensitivity of 87 % and specificity of 86 %. These results suggest that the TVD can predict rebleeding in peptic ulcers with an accuracy similar to that of endoscopic identification of a visible vessel.