Division of Gastroenterology, MOB 233, William Beaumont Hospital, 3535 West Thirteen Mile Road, Royal Oak, MI 48073, USA.
Nat Rev Gastroenterol Hepatol. 2010 Apr;7(4):214-29. doi: 10.1038/nrgastro.2010.24. Epub 2010 Mar 9.
Endoscopy is the primary diagnostic and therapeutic tool for upper gastrointestinal bleeding (UGIB). The performance of endoscopic therapy depends on findings of stigmata of recent hemorrhage (SRH). For peptic ulcer disease-the most common etiology of UGIB-endoscopic therapy is indicated for findings of major SRH, such as active bleeding, oozing, or the presence of a nonbleeding visible vessel, but not indicated for minor SRH, such as a pigmented flat spot or a simple ulcer with a homogeneous clean base. Endoscopic therapies include injection, ablation, and mechanical therapy. Monotherapy reduces the risk of rebleeding in patients with peptic ulcer disease with major SRH to about 20%. Combination therapy, especially injection followed by either ablation or mechanical therapy, is generally recommended to further reduce the risk of rebleeding to about 10%. Endoscopic dual hemostasis by an experienced endoscopist reduces the risk of rebleeding, the need for surgery, the number of blood transfusions required, and the length of hospital stay. This Review article comprehensively analyzes the principles, indications, instrumentation, techniques, and efficacy of endoscopic hemostasis.
内镜检查是上消化道出血（UGIB）的主要诊断和治疗工具。内镜治疗的效果取决于近期出血征象（SRH）的发现。对于消化性溃疡病——UGIB 最常见的病因——内镜治疗适用于主要 SRH 的发现，如活动出血、渗血或可见非出血性血管的存在，但不适用于次要 SRH 的发现，如色素沉着的平坦斑点或具有均匀清洁基底的单纯溃疡。内镜治疗包括注射、消融和机械治疗。单一疗法可将消化性溃疡病伴主要 SRH 患者的再出血风险降低至约 20%。联合治疗，特别是注射后再进行消融或机械治疗，通常被推荐用于进一步将再出血风险降低至约 10%。有经验的内镜医生进行内镜双重止血可降低再出血风险、手术需求、所需输血的数量和住院时间。这篇综述文章全面分析了内镜止血的原理、适应证、仪器、技术和疗效。
