Hui Aric J, Sung Joseph J Y
Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N. T., Hong Kong SAR, China.
Curr Treat Options Gastroenterol. 2005 Apr;8(2):153-162. doi: 10.1007/s11938-005-0008-x.
Endoscopic therapy for nonvariceal bleeding should only be used if major stigmata of hemorrhage such as active bleeding and nonbleeding visible vessel are present. Treatment of peptic ulcers with adherent clots is currently controversial. Combination of epinephrine injection and coaptive coagulation is most effective in achieving endoscopic hemostasis. Hemoclips may be preferable for very deep ulcers and large visible blood vessels if coaptive coagulation is anticipated to have a high risk of perforation or bleeding. Adrenaline injection or hemoclip application should be used in bleeding Mallory-Weiss tears, as the safety of thermal methods is not well established. Argon plasma coagulation is the mainstay of endoscopic treatment for superficial lesions such as angiodysplasia and gastric antral vascular ectasia. Both sclerotherapy and band ligation are effective in acute hemostasis of bleeding esophageal varices. Variceal band ligation is preferred due to its superior safety profile and shorter procedure time. Due to the early recurrence of varices after banding ligation, there may be a role for metachronous combination therapy of ligation followed by sclerotherapy. Histoacryl glue is the preferred method of endoscopic hemostasis in gastric varices.
仅当存在诸如活动性出血和非出血性可见血管等主要出血征象时，才应使用内镜治疗非静脉曲张性出血。目前，对于附着血凝块的消化性溃疡的治疗存在争议。肾上腺素注射与套扎凝血联合应用在实现内镜止血方面最为有效。如果预计套扎凝血有较高的穿孔或出血风险，对于非常深的溃疡和大的可见血管，使用止血夹可能更为可取。对于出血性马洛里-魏斯撕裂，应使用肾上腺素注射或应用止血夹，因为热凝方法的安全性尚未明确确立。氩离子凝固术是治疗诸如血管发育异常和胃窦血管扩张等浅表病变的内镜治疗的主要方法。硬化疗法和套扎术在食管静脉曲张出血的急性止血中均有效。由于套扎术的安全性更高且操作时间更短，因此更倾向于使用静脉曲张套扎术。由于套扎术后静脉曲张早期复发，可能需要在套扎术后同步联合硬化疗法进行治疗。组织黏合剂是胃静脉曲张内镜止血的首选方法。
