Usefulness of Appropriate Management of Ulcer with FORREST II Bleeding Activity: A Prospective, Randomized Study

This study is to compare the clinical and cost effectiveness of various pharmacologic therapies with of without endoscopic procedure in the Forrest II ulcer.

Between May 2001 and June 2002, total of 58 Forrest II bleeding activity patients (37 cases of NBVV, 6 adherent blood clots, 9 flat red spot, and 6 flat black spot) with gastric ulcer(32 cases) and duodenal ulcer(26 cases) were analyzed. UGI endoscopy was performed within 12 hours of the first bleeding episodes, and underwent repetitive endoscopy after 48h. All the patients were randomly assigned to receive somatostatin(group I), PPI(omeparzole : group II), only H2 blocker (famotidine, group III), or endoscopic injection therapy followed by famotidine (group IV). We compared with rebleeding rates, changes of ulcer size, and modified estimated costs for 3 day-hospital in four groups respectively.

1) Twelve patients experienced rebleeding(20.7%). 2) The rates of rebleeding were 16.6% (2/12) in group I, 28.6%(4/14) in group II, 5.9%(1/17) in group III, 26.7% in group IV. There was no significant difference in rebleeding rate among the groups, but there was low rebleeding tendency in group III, compared with group II(p=0.087). 3) Type of stigmata including non-bleeding visible vessels and adherent clots were associated with an increased rate of recurrent bleeding(p=0.01). 4) When modified estimated costs were calculated, group III could be treated at the lowest cost(p<0.05).

In Forrest II bleeding ulcer, medical therapy, especially famotidine could be suggested prudently as a proper treatment modality for this lesion, considering the cost-effectiveness.