Article

Injection therapies for nonvariceal bleeding disorders of the GI tract

Division of Gastroenterology and Hepatology, Stanford University, Stanford, California 94305, USA.
Gastrointestinal Endoscopy (Impact Factor: 4.9). 09/2007; 66(2):343-54. DOI: 10.1016/j.gie.2006.11.019
Source: PubMed
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    ABSTRACT: Bleeding from peptic ulcers can be effectively and safely treated with endoscopic hemoclips therapy. However, due to certain limiting factors of hemoclips, application of combination with another endoscopic method may give better results. The aim of this study was to examine the efficacy and safety of endoscopic hemoclips therapy and to evaluate potential benefits of this therapy combined with epinephrine in the treatment of bleeding peptic ulcers. This prospective randomized study included 70 patients with bleeding gastric or duodenal ulcer. In 34 of the patients endoscopic hemoclips therapy was applied (group I), and in 36 of them a combined therapy of hemoclips and epinephrine (group II). Initial hemostasis was achieved in most patients treated with endoscopic hemoclips therapy (94.1%) as well as in the patients treated with combination therapy (97.2%). After initial hemostasis achieved rebleeding occurred in 3 (9.3%) patients treated with hemoclips and in 2 (5.7%) patients treated with combination therapy, but this difference was not statistically significant (p > 0.05). The difference in the achieved final hemostasis between the group I (91.1%) and the group II (94.4%) was not statistically significant. Also, the differences between the two groups of patients in the need for blood transfusions, length of hospital stay, need for surgery and mortality were not statistically significant (p > 0.05). Endoscopic hemoclips therapy is effective and safe in treatment of bleeding peptic ulcers. Combination therapy of hemoclips and epinephrine has no advantage over hemoclips monotherapy.
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    ABSTRACT: Among the gastrointestinal emergencies, acute upper gastrointestinal bleeding (UGIB) remains a challenging clinical problem owing to significant patient morbidity and costs involved with management. Peptic ulcer bleeding (PUB) contributes to the majority of causes of UGIB with a growing concern of its impact on the elderly and the increasing use of NSAIDs as precipitating bleeding episodes. Apart from initial critical assessment and care, endoscopy remains as the preferred initial management of PUB. Early use of high-dose proton pump inhibitor therapy is cost-effective and reduces the need for endotherapy as well as rebleed rates. Current endoscopic modalities offer a wide range of choices in high-risk PUB (active arterial bleeding or non-bleeding visible vessel). A combination of injection (epinephrine) along with thermal or endoclips therapy offers the best strategy for overall successful clinical outcomes. The role of endotherapy for adherent clots is controversial. A second-look endoscopy may be beneficial in high-risk patients. A multidisciplinary team approach should be part of all treatment protocols for the ideal management of UGIB.Copyright © 2010 S. Karger AG, Basel
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    ABSTRACT: Abstract Introduction: This study aimed to assess the safety and effectiveness of covered self-expanding metal stents for the treatment of nonvariceal esophageal bleeding in patients for whom routine therapies have failed. Patients and Methods: A retrospective analysis was conducted on patients with esophageal bleeding in our hospital. Data on hemostatic effects and complications were collected from patients who underwent esophageal stenting. Results: In total, 4 patients were treated with five stents. In all 4 patients, the placement of esophageal stents immediately stopped the ongoing bleeding. One patient experienced recurrent bleeding 4 days after the removal of the first stent. Hemostasis was achieved after the insertion of a second stent. No stent-related complications occurred during or after stent implantation in the other 3 patients. Conclusions: The implantation of a covered self-expandable metal stent is a safe and effective alternative to treat acute, nonvariceal esophageal bleeding after routine therapies have failed.
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