INTRAVENOUS PROTON-PUMP INHIBITOR (IV PPI) PRIOR TO ENDOSCOPY 'DOWNSTAGE' HIGH RISK LESIONS IN PATIENTS WITH BLEEDING PEPTIC ULCER (PUD): A MULTICENTRE COMPARATIVE STUDY

CN Andrews¹, AR Levy², M Fishman³, M Hahn⁴, K Atkinson⁵, P Kwan⁶, R Enns⁷

¹University of Calgary, Alberta; ²Dept. of Healthcare and Epidemiol; ³Richmond Hosp; ⁴Lion's Gate Hosp; ⁵Royal Columbian Hosp; ⁶Vancouver Gen Hosp; ⁷St.Paul's Hosp, UBC, Vancouver, British Columbia

BACKGROUND: IV PPI lowers rebleeding rates after endoscopic Rx for PUD with high-risk endoscopic stigmata (HRUS). IV PPIs are started before endoscopy in 50% of cases; it is not clear if this provides additional benefit.
OBJECTIVE: To assess whether IV PPI started before endoscopy provides additional benefit in patients with HRUS.
METHODS: Patients who received IV pantoprazole bolus and infusion undergoing endoscopy (6 hospitals-11/99 to 08/01) were reviewed. Only patients with HRUS (active bleeding, non-bleeding visible vessel, adherent clot) were included. Demographics, Forrest class, and outcomes were compared between those receiving IV PPI before and after endoscopy. Active bleeding was defined as Forrest 1a /1b lesion.
RESULTS: 'Before' group had median 15.4 h (0.3-57) of IV PPI infusion prior to endoscopy. 'After' group had IV PPI infusion started median 3.7h (0-37) after endoscopy. Both groups were similar in terms of age, sex, comorbidity, lowest Hgb and BP, transfusion needs, and length of stay. See table.
CONCLUSION: IV PPI infusion prior to endoscopy downstages bleeding lesions at endoscopy, but does not affect rates of rebleeding, surgery, or death. Given the relatively small sample size, this may in fact differ among sub-groups with varying clinical characteristics.