Recurrent Bleeding

Although initial hemostasis rates following endoscopic treatment in patients with severe bleeding ulcers exceed 94%, the rate of recurrent bleeding is substantial (15 to 20%). The patients at highest risk of recurrent bleeding are those whose bleeding developed during hospitalization for another reason, and those with large or deep ulcers, hypotension at presentation, comorbid illness, and severe coagulopathy.

Recurrent bleeding may be managed by endoscopic re-treatment or emergency surgery. Recurrent bleeding from small ulcers is often the result of inadequate initial thermocoagulation and endoscopic retreatment is worthwhile in these circumstances.

Lau and colleagues (1999) compared emergency surgery to endoscopic retreatment for recurrent bleeding after initial endoscopic hemostasis using epinephrine plus HP. Forty-eight patients were randomized to endoscopic retreatment and 44 were randomized to surgery. The recurrent bleeding rate was 8.7%, which is lower than the rates (15 to 25%) reported in other studies. Although the long term hemostasis rate was lower with endoscopic retreat-ment (73% vs 93%), the complication rate was significantly higher in the surgical group (36.4 % vs 14.6%), despite the higher rate of ulcer perforation observed with endoscopic retreatment over initial treatment. Hospital length of stay, transfusion requirements, and 30-day mortality did not differ between the groups.

Further randomized trials are needed to determine whether other modalities such as hemoclipping can increase the rate of long term endoscopic hemostasis. In addition, the role of preemptive elective surgery following endoscopic retreatment in patients at high risk of recurrent bleeding should be evaluated.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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