Jensen Dennis M
David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center and The VA Greater Los Angeles Healthcare System, Los Angeles, CA 90095, USA.
J Clin Med. 2023 Oct 11;12(20):6473. doi: 10.3390/jcm12206473.
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common medical problem worldwide. Independent endoscopic risk factors for rebleeding and mortality of NVUGIB that are treatable are stigmata of recent hemorrhage (SRH) and arterial blood flow underneath SRH. The specific aims of this paper are to describe the importance of arterial blood flow detection for risk stratification and as a guide to definitive hemostasis of severe NVUGIB.
This is a review of randomized controlled trials and prospective cohort study methodologies and results which utilized a Doppler endoscopic probe (DEP) for the detection of arterial blood underneath SRH, for risk stratification, and as a guide to definitive hemostasis. The results are compared to visually guided hemostasis based upon SRH.
Although SRH have been utilized to guide endoscopic hemostasis of NVUGIB for 50 years, when most visually guided treatments are applied to lesions with major SRH, arterial blood flow underneath SRH is not obliterated in 25-30% of patients and results in rebleeding. Definitive hemostasis, significantly lower rebleeding rates, and improvements in other clinical outcomes resulted when DEP was used for risk stratification and as a guide to obliteration of arterial blood flow underneath SRH.
DEP-guided endoscopic hemostasis is a very effective and safe new method to improve patient outcomes for NVUGIB.
非静脉曲张性上消化道出血（NVUGIB）是全球常见的医学问题。NVUGIB再出血和死亡的可治疗的独立内镜危险因素是近期出血征象（SRH）以及SRH下方的动脉血流。本文的具体目的是描述动脉血流检测对于严重NVUGIB风险分层的重要性以及作为确定性止血指导的重要性。
这是一项对随机对照试验以及前瞻性队列研究方法和结果的综述，这些研究使用多普勒内镜探头（DEP）检测SRH下方的动脉血，用于风险分层以及作为确定性止血的指导。将结果与基于SRH的视觉引导止血进行比较。
尽管SRH已被用于指导NVUGIB的内镜止血50年，但当大多数视觉引导治疗应用于有主要SRH的病变时，25%-30%的患者SRH下方的动脉血流未被消除，导致再出血。当使用DEP进行风险分层并作为消除SRH下方动脉血流的指导时，实现了确定性止血、显著降低再出血率以及改善其他临床结局。
DEP引导的内镜止血是一种非常有效且安全的新方法，可改善NVUGIB患者的预后。
