Cipolletta Livio, Cipolletta Fabio, Granata Antonino, Ligresti Dario, Barresi Luca, Tarantino Ilaria, Traina Mario
Endoscopy Unit, Ruesch Clinic, Via San Domenico, 24, 80127, Naples, Italy.
Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy.
Curr Treat Options Gastroenterol. 2018 Dec;16(4):363-375. doi: 10.1007/s11938-018-0192-0.
PURPOSE OF REVIEW: Upper non-variceal gastrointestinal bleeding (UNVGIB) remains an important clinical challenge for endoscopists, requiring skill and expertise for correct management. In this paper, we suggest the best strategy for an effective treatment of this complex category of patients.
Early endoscopic examination, the increasingly widespread use of endoscopic hemostasis methods, and the most powerful antisecretory agents that induce clot stabilization have radically modified the clinical scenario for treating this pathology. While hospitalization for digestive hemorrhage is decreasing, the incidence of bleeding seems to be increasing, especially in the elderly for whom a greater use of gastrolesive drugs and the presence of comorbidities are more common. A multidisciplinary approach for initial patient evaluation and hemodynamic resuscitation prior to endoscopic treatment is crucial for correct management, prevention of rebleeding, and reduction of morbidity and mortality rates and hospital stays. Appropriate operator technical expertise, together with the availability of a wide range of endoscopes and devices, is mandatory. Newer endoscopic techniques may improve patient outcomes for difficult-to-treat lesions. Today, endoscopic hemostasis can be achieved in over 95% of patients.
综述目的：上消化道非静脉曲张性出血（UNVGIB）仍然是内镜医师面临的一项重要临床挑战，正确处理需要技巧和专业知识。在本文中，我们提出了有效治疗这类复杂患者的最佳策略。
早期内镜检查、内镜止血方法的日益广泛应用以及诱导血凝块稳定的最强效抗分泌药物已从根本上改变了治疗这种病症的临床情况。虽然因消化性出血住院的人数在减少，但出血发生率似乎在上升，尤其是在老年人中，他们更多地使用致溃疡药物且合并症更为常见。在内镜治疗前，采用多学科方法对患者进行初始评估和血流动力学复苏对于正确处理、预防再出血以及降低发病率、死亡率和缩短住院时间至关重要。合适的操作者技术专长以及多种内镜和设备的可用性是必不可少的。更新的内镜技术可能会改善难治性病变患者的预后。如今，超过95%的患者可实现内镜止血。
