Fullarton G M, Murray W R
University Department of Surgery, Western Infirmary, Glasgow.
Endoscopy. 1990 Mar;22(2):68-71. doi: 10.1055/s-2007-1012795.
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.
消化性溃疡出血后，准确确定那些再出血风险最高的患者的能力依赖于临床和内镜标准，而这些标准仅在可变比例的病例中准确。在本研究中，我们使用经内镜血管探测器（TVD）评估消化性溃疡再出血的预测，以比较溃疡底部阳性多普勒信号的存在与近期出血的视觉征象（SRH）。在18个月期间接受上消化道出血内镜检查的711例患者中，发现180例（25%）患有消化性溃疡。124例患者在内镜检查时仅有轻微或无SRH，这些患者均未再出血。56例患者有单个消化性溃疡，伴有活动性出血、可见血管或附着血栓，其中22例进入试验。总体而言，该组9例患者（41%）再出血。考虑到再出血的预测，与阳性多普勒信号敏感性87%、特异性86%相比，可见血管的敏感性为89%，特异性为92%。这些结果表明，TVD预测消化性溃疡再出血的准确性与内镜识别可见血管的准确性相似。
