病变血流能为非静脉曲张性上消化道出血的风险分层及成功管理告诉我们什么？
What Does Lesion Blood Flow Tell Us About Risk Stratification and Successful Management of Non-variceal UGI Bleeding?
作者信息
Ghassemi Kevin A, Jensen Dennis M
机构信息
Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza #205, Los Angeles, CA, 90095, USA.
CURE Digestive Diseases Research Center, Los Angeles, USA.
出版信息
Curr Gastroenterol Rep. 2017 Apr;19(4):17. doi: 10.1007/s11894-017-0556-y.
PURPOSE OF REVIEW
There has been a decline in mortality associated with upper gastrointestinal (UGI) hemorrhage as the use of urgent endoscopy has increased. This review will examine endoscopic risk stratification of non-variceal UGI bleeding (e.g., ulcers, Dieulafoy lesions, and Mallory-Weiss tears), including the use of the Doppler endoscopic probe (DEP).
RECENT FINDINGS
Prospective studies evaluating the use of DEP in non-variceal UGI hemorrhage showed that lesions with high-risk stigmata of recent hemorrhage (SRH) have a higher rate of a positive DEP signal compared to those with intermediate-risk SRH. Additionally, lesions with a persistently positive DEP signal after endoscopic hemostasis were seen with high-risk SRH and had a higher 30-day rebleeding rate. Residual arterial blood flow underneath ulcers is a significant risk factor for rebleeding. However, if more endoscopic treatment is applied, clinical outcomes for patients with severe non-variceal UGI hemorrhage are improved, as documented by a recent CURE Hemostasis randomized controlled trial (RCT).
综述目的
随着急诊内镜检查的使用增加，上消化道（UGI）出血相关的死亡率有所下降。本综述将探讨非静脉曲张性UGI出血（如溃疡、Dieulafoy病变和马洛里-魏斯撕裂）的内镜风险分层，包括多普勒内镜探头（DEP）的使用。
最新发现
评估DEP在非静脉曲张性UGI出血中应用的前瞻性研究表明，与中度风险近期出血（SRH）的病变相比，具有近期出血高风险特征的病变DEP信号阳性率更高。此外，内镜止血后DEP信号持续阳性的病变见于高风险SRH，且30天再出血率更高。溃疡下方的残余动脉血流是再出血的一个重要危险因素。然而，如最近的CURE止血随机对照试验（RCT）所记录的，如果应用更多的内镜治疗，严重非静脉曲张性UGI出血患者的临床结局会得到改善。
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