Health  Vol.2 No.6 , June 2010
Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer
Acute upper gastrointestinal bleeding (UGIB) remains an important emergency situation. In the last two decades, major developments took place influencing incidence, etiology and outcome of patients with acute UGIB. Peptic ulcer bleeding is the most significant complication of ulcer disease being responsible for 50% of all cases mortality. Aim of the study: To compare between endoscopic clip application versus argon plasma coagulation in management of bleeding peptic ulcer (BPU). Patients and Methods: Sixty patients suffering from acute UGIB were randomly divided into two groups: group I included 30 patients treated with endoscopic clip application and Group II included 30 patients subjected to endoscopic APC. All patients were classified according to Forrest classification and the clinical Rockall score. Results: There were significant differences between the two groups as regard Forrest classification (P < 0.05) there were insignificant difference between the two groups as regard rockall score, site of the ulcer and re bleeding (P > 0.05). Re bleeding was significant with higher Rockall score in group I (P < 0.05) but it was insignificant in group II (P > 0.05). Conclusion: Endoscopic application of hemoclips have a less re bleeding rate than Argon plasma coagulation for treatment of bleeding peptic ulcer, although this was statistically insignificant, meanwhile APC is still less cost and easy. Clinical and endoscopic assessment (through Rokcall score and Forrest classification) could help in making best choice for endoscopic management.

Cite this paper
nullAssal, H. , Elsherbiny, A. , Badawy, H. , Nashaat, E. and Shabrawi, H. (2010) Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer. Health, 2, 634-638. doi: 10.4236/health.2010.26096.
[1]   Barkun, A., et al. (2003) Consensus for managing patients with non variceal upper gastrointestinal bleeding. Annals of Internal Medicine, 139(10), 843-857.

[2]   Park, C.H., et al. (2004) Optimal volume for epinephrene for endoscpic prevention of recurrent peptic bleeding. Gastrointestinal Endoscopy, 60(6), 875-880.

[3]   Canard, J.M. and Vedrenne, B. (2001) Clinical application of argon plasma coagulation in gastrointestinal endoscopy: has the time come to replace the laser? Endoscopy, 33(4), 353-357.

[4]   Church, N.I., Dallal, H.J., Masson, J., et al. (2003) A randomized trial comparing heater probe plus thrombin with heater probe plus placebo for bleeding peptic ulcer. Gastroenterology, 125(2), 396-403.

[5]   Devereaux, C.E. and Binmoeller, K.F (1999) Endoclip: closing the surgical gap. Gastrointestinal Endoscopy, 50 (3), 440-442.

[6]   Forrest, J.A.H., Finlayson, N.D.C. and Shearman, D.J.C. (1974) Endoscopy in gastrointestinal bleeding. Lancet,2(7877), 394-397.

[7]   Rockall, T.A., Logan, R.F., Devlin, H.B. and Northfield, T.C. (1995) Incidence of and mortality from acute upper gastrointestinal haemorrage in the United Kingdom. Steering Committee Gastrointestinal Haemorrhage, British Medical Journal, 311(6999), 222-226.

[8]   Leerdam, V. (2008) Epidemiology of acute upper gastrointestinal bleeding. Best Practice & Research Clinical Gastroenterology, 22(2), 209-224.

[9]   Sung, J. (2006) Current manegement of peptic ulcer bleeding. Nature Clinical Practice Gastroenterology & Hepatology, 3, 24-32.

[10]   Chuttani, R., Barkun, A., Carpenter, S., et al. (2006) Endoscopic clip application devices. American Society for Gastrointestinal Endoscopy, 63(6), 16-51.

[11]   Aabakken, L. (2008) Current endoscopic and pharmacological therapy of peptic ulcer bleeding. Best Practice & Research Clinical Gastroenterology, 22(2), 243-259.

[12]   Saperas, E., Sebastian, V., Carolina, B., Joan, D., Jose, R. and Juan, R.M. (2008) Applicability of the Rockall scoring system and prediction of rebleeding and mortality after combined pharmacologic and endoscopic treatment of high-risk bleeding peptic ulcers. Gastrointestinal Endoscopy, 67(5), AB255.

[13]   Chung, I.K., Ham, J.S., Kim, H.S., et al. (1999) Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding pepic ulcers. Gastrointestinal Endoscopy, 49(1), 13-18.

[14]   Bessa, X., O’Callaghan, E., Ballesté, B., Nieto, M., et al. (2006) Applicability of the Rockall score in patients undergoing endoscopic therapy for upper gastrointestinal bleeding. Digestive and Liver Disease, 38(1), 12-17.

[15]   Church, N.I. and Palmer, K.R. (2001) Relevance of the Rockall score in patients undergoing endoscopic therapy for peptic ulcer hemorrhage. European Journal of Gastroenterology and Hepatology, 13(10), 1149-1152.

[16]   Chuan, C., Ming-Szu, H., Te-Fa, C., Jih-Chang, C. and Cheng-Ting, H. (2007) Risk scoring systems to predict need for clinical intervention for patients with non variceal upper gastrointestinal tract bleeding. American Journal of Emergency Medicine, 25(7), 774-779.

[17]   Sung, J.J., Tosi, K.K., Lai, L.H., et al. (2007) Endoscopic clipping versus injection and thermocagulation in treatment of non variceal upper gastrointestinal bleeding: A meta-analysis. Gut, 56, 1364-1373.