Abstract：
BACKGROUND: Currently, there is no clear consensus on whether medical treatment or endoscopic treatment should be used for peptic ulcer bleeding patients with adherent clot. The aim of this study is to investigate the hemostatic effects of medical treatment, single endoscopic treatment, and combination endoscopic treatment for peptic ulcer bleeding (PUB) patients with adherent clot.
METHODS: We retrospectively analyzed PUB patients with adherent clot who underwent endoscopic examination or treatment in our center from March 2014 to January 2023 and received intravenous administration of proton pump inhibitors. Patients were divided into medical treatment (MT) group, single endoscopic treatment (ST) group, and combined endoscopic treatment (CT) group. Subsequently, inverse probability of treatment weighting (IPTW) was performed to calculate the rebleeding rate.
RESULTS: A total of 605 eligible patients were included in this study. After IPTW, the rebleeding rate in the MT group on days 3, 7, 14, and 30 were 13.3 (7.3), 14.2 (7.8), 14.5 (7.9), and 14.5 (7.9), respectively; the rebleeding rates in the ST group were 17.4 (5.1), 20.8 (6.1), 20.8 (6.1), and 20.8 (6.1), respectively; the rebleeding rates in the CT group were 0.4 (0.9), 1.7 (3.3), 2.3 (4.5), and 2.3 (4.5), respectively. Although the rebleeding rate in the medical treatment group was higher, there was no significant difference among the three groups on days 3, 7, 14, and 30 (P = 0.132, 0.442, 0.552, and 0.552).
CONCLUSIONS: Medical therapy has similar hemostatic efficacy with endoscopic treatment for PUB patients with adherent clot (FIIb ulcers). However, for patients with more risk factors and access to well-equipped endoscopy centers, endoscopic treatment may be considered. The choice of treatment approach should be based on the individual conditions of the patient, as well as other factors such as medical resources available.
METHODS: We retrospectively analyzed PUB patients with adherent clot who underwent endoscopic examination or treatment in our center from March 2014 to January 2023 and received intravenous administration of proton pump inhibitors. Patients were divided into medical treatment (MT) group, single endoscopic treatment (ST) group, and combined endoscopic treatment (CT) group. Subsequently, inverse probability of treatment weighting (IPTW) was performed to calculate the rebleeding rate.
RESULTS: A total of 605 eligible patients were included in this study. After IPTW, the rebleeding rate in the MT group on days 3, 7, 14, and 30 were 13.3 (7.3), 14.2 (7.8), 14.5 (7.9), and 14.5 (7.9), respectively; the rebleeding rates in the ST group were 17.4 (5.1), 20.8 (6.1), 20.8 (6.1), and 20.8 (6.1), respectively; the rebleeding rates in the CT group were 0.4 (0.9), 1.7 (3.3), 2.3 (4.5), and 2.3 (4.5), respectively. Although the rebleeding rate in the medical treatment group was higher, there was no significant difference among the three groups on days 3, 7, 14, and 30 (P = 0.132, 0.442, 0.552, and 0.552).
CONCLUSIONS: Medical therapy has similar hemostatic efficacy with endoscopic treatment for PUB patients with adherent clot (FIIb ulcers). However, for patients with more risk factors and access to well-equipped endoscopy centers, endoscopic treatment may be considered. The choice of treatment approach should be based on the individual conditions of the patient, as well as other factors such as medical resources available.
摘要：
背景：目前，对于有粘连性凝块的消化性溃疡出血患者，是否应采用药物治疗或内镜治疗，目前尚无明确共识。这项研究的目的是探讨药物治疗的止血效果，单内镜治疗，和联合内镜治疗消化性溃疡出血（PUB）患者粘连凝块。
方法：我们回顾性分析了2014年3月至2023年1月在我们中心接受内镜检查或治疗并接受质子泵抑制剂静脉给药的有粘连凝块的PUB患者。将患者分为药物治疗（MT）组，单内镜治疗（ST）组，联合内镜治疗(CT)组。随后，进行治疗加权的逆概率(IPTW)以计算再出血率。
结果：本研究共纳入605名符合条件的患者。IPTW之后,MT组在第3、7、14和30天的再出血率分别为13.3（7.3），14.2(7.8),14.5(7.9),和14.5(7.9)，ST组的再出血率分别为17.4(5.1),20.8(6.1),20.8(6.1),和20.8（6.1），CT组再出血率分别为0.4(0.9),1.7(3.3)、2.3(4.5),和2.3（4.5），分别。虽然药物治疗组的再出血率较高,在第3、7、14和30天，三组之间没有显着差异（P=0.132、0.442、0.552和0.552）。
结论：对于有粘连性血块（FIIb溃疡）的PUB患者，药物治疗与内镜治疗具有相似的止血效果。然而,对于有更多危险因素并且可以使用设备齐全的内窥镜检查中心的患者，可以考虑内镜治疗。治疗方法的选择应根据患者的个人情况，以及其他因素，如可用的医疗资源。
方法：我们回顾性分析了2014年3月至2023年1月在我们中心接受内镜检查或治疗并接受质子泵抑制剂静脉给药的有粘连凝块的PUB患者。将患者分为药物治疗（MT）组，单内镜治疗（ST）组，联合内镜治疗(CT)组。随后，进行治疗加权的逆概率(IPTW)以计算再出血率。
结果：本研究共纳入605名符合条件的患者。IPTW之后,MT组在第3、7、14和30天的再出血率分别为13.3（7.3），14.2(7.8),14.5(7.9),和14.5(7.9)，ST组的再出血率分别为17.4(5.1),20.8(6.1),20.8(6.1),和20.8（6.1），CT组再出血率分别为0.4(0.9),1.7(3.3)、2.3(4.5),和2.3（4.5），分别。虽然药物治疗组的再出血率较高,在第3、7、14和30天，三组之间没有显着差异（P=0.132、0.442、0.552和0.552）。
结论：对于有粘连性血块（FIIb溃疡）的PUB患者，药物治疗与内镜治疗具有相似的止血效果。然而,对于有更多危险因素并且可以使用设备齐全的内窥镜检查中心的患者，可以考虑内镜治疗。治疗方法的选择应根据患者的个人情况，以及其他因素，如可用的医疗资源。
