Reuters Health Information: Doppler probe-guided hemostasis improves outcomes in nonvariceal upper GI bleeding
Doppler probe-guided hemostasis improves outcomes in nonvariceal upper GI bleeding
Last Updated: 2017-02-24
By Will Boggs MD
NEW YORK (Reuters Health) - Using a Doppler probe to guide
endoscopic hemostasis improves outcomes of patients with severe
nonvariceal upper gastrointestinal (UGI) bleeding, researchers
Residual arterial blood flow at the site of UGI bleeding
independently predicts rebleeding, yet arterial flow at
endoscopy has been studied or used to guide treatment only
infrequently, according to the team.
To investigate, Dr. Dennis M. Jensen from David Geffen
School of Medicine at UCLA, Los Angeles, and colleagues
performed a randomized trial of 148 patients with severe
nonvariceal UGI hemorrhage.
Compared with the control group that underwent standard,
visually guided endoscopic hemostasis, the Doppler group had a
significantly lower rebleeding rate (11.1% vs. 26.3%),
regardless of the specific visual sign used to guide treatment
in the control group.
The number needed to treat to prevent one episode of
rebleeding was seven.
Among patients who did rebleed, those in the control group
rebled about a day sooner than those in the Doppler group, the
researchers report in Gastroenterology, online February 3.
There was a strong association between residual blood flow
after endoscopic hemostasis and rebleeding rates. Most patients
in the Doppler group with residual blood flow that could not be
completely obliterated (eight of nine) rebled, whereas none of
eight whose residual blood flow was obliterated with additional
�We recommend that current guidelines for management of
nonvariceal UGI bleeding incorporate these new findings,� the
Dr. Ian Gralnek from the Institute of Gastroenterology and
Liver Diseases at Ha'Emek Medical Center in Afula, Israel, who
helped draft the European Society of Gastrointestinal Endoscopy
guideline for diagnosis and management of nonvariceal UGI
bleeding, told Reuters Health by email, �These data need to be
replicated from other centers at other sites around the world;
if those data are corroborative, then we will need to think
about altering the standard of care recommendations for this
specific patient group.�
�These data may be the start of a change in how endoscopic
hemostasis is performed, but more data are needed before
evidence-based guideline recommendations reflect that,� he said.
Dr. Jensen did not respond to a request for comments.