Zhang Jing, Zhang Jia-ying, Ding Shi-gang, Wang Ye, Zhou Li-ya
Department of Gastroenterology, Peking University Third Hospital, Beijing, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2012 Aug 18;44(4):582-7.
To evaluate the clinical value of endoscopic hemostasis in acute nonvariceal upper gastrointestinal bleeding.
This was a retrospective study of 223 patients with acute nonvariceal upper gastrointestinal bleeding and receiving endoscopic treatment who were admitted to Peking University Third Hospital between January 1, 2005 and December 31, 2009. Endoscopic diagnosis, lesion location, lesion size and stigmata of recent hemorrhage were recorded. Stigmata of recent hemorrhage was evaluated by Forrest classification. All the patients were scored by Rockall for rehemorrhage and death risk. Endoscopic treatment comprised medicine aspersing, injection, thermocoagulation, clips and combination therapy.
Hemorrhagic lesions of Forrest Ia-IIb were selected for endoscopic treatment, in which 214 patients(96.0%,214/223) underwent first endoscopic hemostasis successfully, while rehemorrhage occurred in 34 patients(15.2%,34/223). The first hemostatic achievement rate was 80.7%(180/223). And 17 patients received surgery or died because of endoscopic treatment failure. Total effective rate of endoscopic treatment was 92.4%(206/223). The total effective rates of Rockall high-risk group, moderate-risk group and low-risk group were 80%(40/50),95.7%(156/163) and 100%(10/10) respectively. The effective rates of epinephrine injection and combination therapy were 92.6%(137/148) and 77.6%(38/49) respectively. The rehemorrgagic rates of epinephrine injection and combination therapy were 14.2%(21/148) and 18.4%(9/49) respectively. The proportion of combination therapy in the second attempt at endoscopic therapy was 65.0%(13/20), and the achievement rate was 61.5%(8/13).
Endoscopic hemostatic therapy is the preferred emergency treatment in acute nonvariceal upper gastrointestinal bleeding. Endoscopic treatment should be used for emorrhagic lesions of Forrest Ia-IIb. Endoscopic therapy could be completely hemostatic in Rockall low-risk group. Rockall score directly influences endoscopic treatment effectiveness.
评估内镜止血在急性非静脉曲张性上消化道出血中的临床价值。
这是一项对2005年1月1日至2009年12月31日期间北京大学第三医院收治的223例接受内镜治疗的急性非静脉曲张性上消化道出血患者的回顾性研究。记录内镜诊断、病变部位、病变大小及近期出血征象。近期出血征象采用Forrest分类法评估。所有患者均采用Rockall评分评估再出血及死亡风险。内镜治疗包括药物喷洒、注射、热凝、钛夹及联合治疗。
选择Forrest Ia-IIb级出血性病变进行内镜治疗，其中214例患者（96.0%，214/223）首次内镜止血成功，34例患者（15.2%，34/223）发生再出血。首次止血成功率为80.7%（180/223）。17例患者因内镜治疗失败接受手术或死亡。内镜治疗总有效率为92.4%（206/223）。Rockall高危组、中危组和低危组的总有效率分别为80%（40/50）、95.7%（156/163）和100%（10/10）。肾上腺素注射和联合治疗的有效率分别为92.6%（137/148）和77.6%（38/49）。肾上腺素注射和联合治疗的再出血率分别为14.2%（21/148）和18.4%（9/49）。联合治疗在内镜治疗第二次尝试中的比例为65.0%（13/20），成功率为61.5%（8/13）。
内镜止血治疗是急性非静脉曲张性上消化道出血的首选紧急治疗方法。内镜治疗应适用于Forrest Ia-IIb级出血性病变。内镜治疗在Rockall低危组可实现完全止血。Rockall评分直接影响内镜治疗效果。
