소화성 궤양의 재출혈에서 반복적인 내시경적 지혈술의 유용성과 치료 실패의 예측인자

Abstract

Background/Aims: After endoscopic treatment of peptic ulcer bleeding, rebleeding occurs in 15 to 20 percent of patients. We investigated the factors predicting the failure of initial endoscopic treatment in patients with peptic ulcer bleeding and the usefulness of repeated endoscopic treatment in peptic ulcer patients with rebleeding after initial endoscopic treatment. Methods: Clinical data were retrospectively collected from 376 patients (311 males and 65 females, mean age 53.9 years) with peptic ulcer bleeding between June 1995 and May 1999. Results: Of 376 patients, rebleeding after initial endoscopic treatment occurred in 50 patients (13.3%). Eight patients who failed to initial endoscopic hemostasis underwent operation immediately. The presence of major stigmata on endoscopy (p=0.001) and shock at admission (p=0.001) were two significantly independent factors predictive of rebleeding after initial endoscopic treatment. Among the patients with rebleeding, repeated endoscopic treatment was successful in 26 patients (61.9%), but 16 patients (38.1%0 underwent salvage surgery due to the failure of hemostasis. Patients who did not respond to endoscopic retreatment were more likely to have ulcers ≥2 cm in diameter (p=0.027). Conclusions: Repeated endoscopic treatment can reduce the need for surgery. Ulcer size ≥2cm is an independent factor in predicting the failure of repeated endoscopic treatment in peptic ulcer patients with rebleeding. Therefore, surgery should be considered in the case.