risk of rebleeding with adherent clot
Dr Howden and his colleagues mentioned in their systematic review (1) that patients with bleeding peptic ulcers with endoscopic findings of adherent clot has low risk of rebleeding, however the risk of rebleeding in the reference mentioned in their systematic review (2) was 35.3% for medically treated patients versus 0% endoscopically treated patients (P = 0.011). In a another RCT (3) which compared endoscopic treatment versus medical therapy for patients with adherent clot , the risk of rebleeding was 34.1 % for patients who received medical treatment versus 4.8% in the endoscopic treatment arm , which again you cannot consider it as low risk for rebleeding .
Hussam Ammar MD Missouri , USA
1-Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding .Grigoris I Leontiadis, Virender K Sharma, Colin W Howden
2-Jensen DM, Kovacs TO, Jutabha R, Machicado GA, Gralnek IM, Savides TJ, Smith J, Jensen ME, Alofaituli G, Gornbein J. Gastroenterology. 2002 Aug;123(2):407-13.
3-Bleau, BL, Gostout, CJ, Sherman, KE, et al. Recurrent bleeding from peptic ulcer associated with adherent clot: A randomized study comparing endoscopic treatment with medical therapy. Gastrointest Endosc 2002; 56(1): 1-6
Competing interests: None declared
Competing interests: No competing interests