Distinctive aspects of peptic ulcer disease, Dieulafoy's lesion, and Mallory-Weiss syndrome in patients with advanced alcoholic liver disease or cirrhosis

Table 8 Classification of endoscopic stigmata of recent hemorrhage for acute upper gastrointestinal bleeding from peptic ulcer disease

Endoscopic SRH	Endoscopic appearance	Endoscopic therapy	Endoscopic therapy and rationale for therapy
Major SRH
Active bleeding	Active bleeding observed at EGD	Yes	Reduction from 90% to 15% risk of ongoing bleeding with performance of endoscopic therapy
Nonbleeding visible vessel	Pigmented elevation (projection) from ulcer base, whether red, blue or gray in color	Yes	Reduction from about 50% to 15% risk of rebleeding with performance of endoscopic therapy
Intermediate SRH
Adherent clot	Focal clot that is resistant to removal by mild-to-moderate irrigation	Recommended by most endoscopists
Active oozing of blood	Active oozing observed at EGD	Generally recommended	May reduce risk of rebleeding from 28% to 15% with endoscopic therapy
Minor SRH
Flat pigmented spot	Pigmented spot, whether red, blue or gray, which lies flat on the ulcer base	No	Low risk of rebleeding of about 13% with medical therapy alone
No SRH
Homogeneous, clean-based ulcer	Simple ulcer with no bleeding, no adherent clot, no visible vessel and no pigmented spot	No	Extremely low risk of rebleeding of about 4% that does not warrant the risks of endoscopic therapy

Adapted from Cappell[135]. SRH: Stigmata of recent hemorrhage; EGD: Esophagogastroduodenoscopy.