Cappell M S, Abdullah M
Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York, USA.
Gastroenterol Clin North Am. 2000 Mar;29(1):125-67, vi-vii. doi: 10.1016/s0889-8553(05)70110-2.
Therapeutic gastrointestinal endoscopy has a much greater risk of inducing gastrointestinal hemorrhage than diagnostic endoscopy. For example, colonoscopic polypectomy has a risk of approximately 1.6% of inducing bleeding, compared with a risk of approximately 0.02% for diagnostic colonoscopy. Higher-risk procedures include colonoscopic polypectomy, endoscopic biliary sphincterotomy, endoscopic dilatation, endoscopic variceal therapy, percutaneous endoscopic gastrostomy, and endoscopic sharp foreign body retrieval. The risk of inducing hemorrhage is decreased by meticulous endoscopic technique. Hemorrhage from endoscopy may be immediate or delayed. Immediate hemorrhage should be immediately treated by endoscopic hemostatic therapy, including injection therapy, thermocoagulation, or electrocoagulation. Delayed hemorrhage generally requires repeat endoscopy for diagnosis and for therapy, using the same hemostatic techniques.
治疗性胃肠内镜检查比诊断性内镜检查诱发胃肠道出血的风险要高得多。例如，结肠镜息肉切除术诱发出血的风险约为1.6%，而诊断性结肠镜检查的风险约为0.02%。高风险操作包括结肠镜息肉切除术、内镜下胆管括约肌切开术、内镜扩张术、内镜下静脉曲张治疗、经皮内镜下胃造口术以及内镜下尖锐异物取出术。细致的内镜技术可降低诱发出血的风险。内镜检查引起的出血可能是即时性的，也可能是延迟性的。即时性出血应立即采用内镜止血治疗，包括注射治疗、热凝治疗或电凝治疗。延迟性出血一般需要再次进行内镜检查以明确诊断并进行治疗，采用相同的止血技术。
