Gastrointestinal Endoscopy Laboratory, WAM University Hospital, Medical University of Lodz, Poland.
Arch Med Sci. 2010 Aug 30;6(4):599-604. doi: 10.5114/aoms.2010.14474. Epub 2010 Sep 7.
In every case of upper gastrointestinal bleeding suspicion, an endoscopic examination ought to be performed as a matter of urgency. Finding active bleeding, a visible non-bleeding vessel or a lesion with an adherent clot should be followed by application of an available method of endoscopic therapy. The aim of the study was to compare the effectiveness of various endoscopic treatment techniques such as epinephrine injections, coagulation methods and mechanical methods in the treatment of non-varicose upper gastrointestinal bleeding.
Sixty cases of non-varicose upper gastrointestinal bleeding were analysed in terms of the effectiveness of the above-mentioned procedures used in monotherapy or in combination therapy comprising epinephrine injections and clips application. The choice of the applied procedure depended on morphological features and location of the bleeding source, the patient's general condition, as well as technical equipment and manual skills of the endoscopy staff.
The study confirmed the effectiveness of endoscopic treatment of non-varicose upper gastrointestinal bleeding applying the above-mentioned methods. In most patients, this treatment enabled traumatic surgical intervention to be avoided; it was required in only 3 (5%) out of 60 patients with confirmed upper gastrointestinal bleeding. With the first endoscopy, haemostasis was achieved in 47 cases (78.3%) and the second endoscopy, performed due to bleeding recurrence, was successful in the remaining 10 cases (16.7%).
In non-varicose upper gastrointestinal bleeding, urgent diagnostic and therapeutic endoscopy should be the first-line management. If the lesion that is the source of bleeding is possible to localize, the endoscopic techniques should be applied. Among the endoscopic procedures used in monotherapy, clips appeared to be the most effective, their effectiveness being comparable to combination therapy. In bleeding from extensive lesions, coagulation methods are considered to be the most efficacious.
在上消化道出血的每一个疑似病例中，都应紧急进行内镜检查。如果发现活动性出血、可见非出血性血管或附有血栓的病变，应采用现有的内镜治疗方法。本研究旨在比较肾上腺素注射、凝固方法和机械方法等各种内镜治疗技术在非静脉曲张性上消化道出血治疗中的疗效。
分析了 60 例非静脉曲张性上消化道出血患者，评估了上述单独应用或联合应用肾上腺素注射和夹闭治疗的疗效。应用程序的选择取决于出血源的形态特征和位置、患者的一般情况，以及内镜工作人员的技术设备和操作技能。
研究证实了应用上述方法治疗非静脉曲张性上消化道出血的有效性。在大多数患者中，这种治疗避免了创伤性手术干预；仅在 60 例确诊为上消化道出血的患者中，有 3 例（5%）需要进行这种治疗。在首次内镜检查中，47 例（78.3%）实现了止血，由于出血复发而进行的第二次内镜检查在其余 10 例（16.7%）中成功。
在非静脉曲张性上消化道出血中，紧急诊断和治疗性内镜检查应作为一线治疗方法。如果可能定位出血病变，应应用内镜技术。在单独应用的内镜程序中，夹闭似乎是最有效的，其疗效与联合治疗相当。在广泛病变出血中，凝固方法被认为是最有效的。
