How are ulcers with an overlying blood clot treated?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
  • Print
Answer

In the patient who has an ulcer with an overlying clot, attempting to remove the clot by target washing is critical to allow treatment of the underlying stigmata if appropriate. Endoscopic removal of the clot by washing or cold snare has been demonstrated to be effective in reducing the recurrence of bleeding. [125]

The findings under the clot (eg, bleeding vessel, visible vessel, clean base, examples of which are seen in the images below) help to determine the therapy needed and to improve efficacy by allowing treatment to be applied directly to the vessel. (See also the table below.)

Upper gastrointestinal bleeding (UGIB). Ulcer with Upper gastrointestinal bleeding (UGIB). Ulcer with active bleeding.
Upper gastrointestinal bleeding (UGIB). Ulcer with Upper gastrointestinal bleeding (UGIB). Ulcer with a clean base.
Upper gastrointestinal bleeding (UGIB). Diagram of Upper gastrointestinal bleeding (UGIB). Diagram of an ulcer with a clean base.
Upper gastrointestinal bleeding (UGIB). Ulcer with Upper gastrointestinal bleeding (UGIB). Ulcer with an overlying clot.
Upper gastrointestinal bleeding (UGIB). Ulcer with Upper gastrointestinal bleeding (UGIB). Ulcer with a visible vessel.
Upper gastrointestinal bleeding (UGIB). Diagram of Upper gastrointestinal bleeding (UGIB). Diagram of an ulcer with a visible vessel.

Table 5. Ulcer Characteristics and Correlations (Open Table in a new window)

Ulcer Characteristics

Prevalence Rate, %

Rebleeding Rate, %

Surgery Rate, %

Mortality, %

Clean base

42

5

0.5

2

Flat spot

20

10

6

3

Adherent clot

17

22

10

7

Visible vessel

17

43

34

11

Active bleeding

18

55

35

11

If the clot cannot be removed by washing, then using a cold snare can be effective in dislodging and removing the clot.

Vigorous washing of the clot formed after therapy is useful in determining the adequacy of coagulation. A combination of injection with heater probe or bipolar coaptive coagulation is often used and has been shown to be more effective in patients with active bleeding.

The patient is monitored under the protocol for conscious sedation, also called analgesia and sedation (ie, per the American Society of Anesthesiologists [ASA] and the American Society for Gastrointestinal Endoscopy [ASGE] guidelines). In selected cases, monitored anesthesia care has become the preferred option for sedation and endoscopy.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!