• Nobuhito Ito, Kohei Funasaka, Toshihisa Fujiyoshi, Kazuki Nishida, Yusuke Satta, Kazuhiro Furukawa, Naomi Kakushima, Satoshi Furune, Eri Ishikawa, Yasuyuki Mizutani, Tsunaki Sawada, Keiko Maeda, Takuya Ishikawa, Takeshi Yamamura, Eizaburo Ohno, Masanao Nakamura, Ryoji Miyahara, Yoji Sasaki, HarutaJun-IchiJIDepartment of Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Aichi, Japan., Mitsuhiro Fujishiro, and Hiroki Kawashima.
• Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan.
• Ir J Med Sci. 2024 Feb 1; 193 (1): 173179173-179.

BackgroundRebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk score that contribute to rebleeding after endoscopic hemostasis of bleeding peptic ulcers.AimsThe aim of this study was to identify factors associated with rebleeding, including patient factors, after endoscopic hemostasis of bleeding gastroduodenal ulcers and to stratify the risk of rebleeding.MethodsWe retrospectively enrolled 587 consecutive patients who were treated for Forrest Ia to IIa bleeding gastroduodenal ulcers with endoscopic hemostasis at three institutions. Risk factors associated with rebleeding were assessed using univariate and multivariate logistic regression analyses. The Rebleeding Nagoya University (Rebleeding-N) scoring system was developed based on the extracted factors. The Rebleeding-N score was internally validated using bootstrap resampling methods.ResultsSixty-four patients (11%) had rebleeding after hemostasis of gastroduodenal ulcers. Multivariate logistic regression analysis revealed four independent rebleeding risk factors: blood transfusion, albumin <2.5, duodenal ulcer, and diameter of the exposed vessel ≧2 mm. Patients with 4 risk factors in the Rebleeding-N score had a 54% rebleeding rate, and patients with 3 risk factors had 44% and 25% rebleeding rates. In the internal validation, the mean area under the curve of the Rebleeding-N score was 0.830 (95% CI = 0.786-0.870).ConclusionsRebleeding after clip hemostasis of bleeding gastroduodenal ulcers was associated with blood transfusion, albumin <2.5, diameter of the exposed vessel ≧2 mm, and duodenal ulcer. The Rebleeding-N score was able to stratify the risk of rebleeding.© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.

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