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 report.

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 hemostasis rebled.

“We recommend that current guidelines for management of nonvariceal UGI bleeding incorporate these new findings,” the researchers conclude.

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.

SOURCE: http://bit.ly/2lh7Bd5

Gastroenterology 2017.