Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan.
Dig Endosc. 2010 Jul;22 Suppl 1:S15-8. doi: 10.1111/j.1443-1661.2010.00962.x.
Electrocautery forceps with soft coagulation are actively used for treatment of bleeding and nonbleeding visible vessels during endoscopic submucosal dissection, but the usefulness of gastroduodenal ulcer bleeding has not been elucidated so far. The purpose of this paper is to elucidate the outcomes of electrocautery forceps with soft coagulation for peptic and artificial gastroduodenal ulcer bleeding. A retrospective multicenter study of consecutive case series during one year involved nine departments of high-volume hospitals in Japan. The study included 128 consecutive patients (62 with peptic ulcers and 66 with artificial ulcers) with bleeding nonmalignant gastroduodenal ulcers that were revealed using emergency endoscopy between January 2008 and December 2008. Hemostasis was carried out using electrocautery forceps with soft coagulation. Rates of successful initial hemostasis, rebleeding, transfer to surgery, and death according to peptic and artificial ulcer bleeding were recorded. Successful initial endoscopic hemostasis was obtained in 61 peptic ulcer patients (98.4%) and 66 artificial ulcer patients (100%). Rebleeding was observed in seven peptic ulcer patients (11.5%) and five artificial ulcer patients (7.6%). Rates of successful management with endoscopic methods alone were 96.8% (60/62) and 100% (66/66) in peptic ulcer patients and artificial ulcer patients, respectively. There were no severe complications or deaths related to the management of gastroduodenal ulcer bleeding. The novel endoscopic method using electrocautery forceps with soft coagulation for gastroduodenal ulcer bleeding seems to provide safety and efficacy that is comparable with that of endoscopic hemostasis with other established hemostatic techniques.
电凝镊联合软凝法广泛应用于内镜黏膜下剥离术中处理出血和非出血可见血管，但胃十二指肠溃疡出血的疗效尚未阐明。本文旨在阐明电凝镊联合软凝法治疗消化性溃疡和医源性胃十二指肠溃疡出血的效果。本研究为回顾性多中心连续病例系列研究，研究对象为 2008 年 1 月至 2008 年 12 月期间日本 9 家高容量医院的 128 例连续患者（62 例消化性溃疡和 66 例医源性溃疡），这些患者均因非恶性胃十二指肠溃疡出血而行急诊内镜检查。采用电凝镊联合软凝法进行止血。记录根据消化性溃疡和医源性溃疡出血的初始止血成功率、再出血率、转手术率和死亡率。61 例消化性溃疡患者（98.4%）和 66 例医源性溃疡患者（100%）初始内镜止血成功。7 例消化性溃疡患者（11.5%）和 5 例医源性溃疡患者（7.6%）出现再出血。单独采用内镜方法处理的成功率分别为 96.8%（60/62）和 100%（66/66）。在消化性溃疡和医源性溃疡出血的处理中未发生与内镜治疗相关的严重并发症或死亡。电凝镊联合软凝法治疗胃十二指肠溃疡出血是一种新的内镜方法，其安全性和疗效与其他已确立的止血技术相当。
