Lu Meng-Hsuan, Chiang Hsueh-Chien
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 70428, Taiwan.
Therap Adv Gastroenterol. 2024 Sep 8;17:17562848241275318. doi: 10.1177/17562848241275318. eCollection 2024.
Peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, which has a high mortality risk. The standard therapy for acute peptic ulcer bleeding combines medication administration and endoscopic therapies. Both pharmacologic and endoscopic therapies have developed continuously in the past few decades. Proton pump inhibitors (PPIs) already reached a high efficacy in ulcer healing and have been widely used in the past few decades. Endoscopic hemostasis, which includes local epinephrine injection, heater probe coagulation, use of hemostatic clips, and/or band ligation, is highly effective with an overall hemostatic success rate of 85%-90%. However, 10%-20% of patients could not be cured by the current standard combination treatment. Recurrent ulcer bleeding, despite an initial successful hemostasis, is also a big problem for longer hospitalization stays, higher mortality, and higher complication rates, especially for malignant ulcer bleeding. How to manage all types of peptic ulcer bleeding and how to prevent early recurrent peptic ulcer bleeding remain unresolved clinical problems. Recently, several novel medications and endoscopic methods have been developed. Potassium competitive acid blockers have shown a stronger and longer acid suppression than PPI. Hemostatic powder spray and hemostatic gel emulsion are novel hemostatic weapons with emerging evidence, which are potential missing pieces of the puzzle. This literature review will go through the development of endoscopic hemostasis to the prospects of novel endoscopic treatments.
消化性溃疡出血是上消化道出血最常见的原因，具有较高的死亡风险。急性消化性溃疡出血的标准治疗方法是药物治疗和内镜治疗相结合。在过去几十年中，药物治疗和内镜治疗都在不断发展。质子泵抑制剂（PPIs）在溃疡愈合方面已经达到了很高的疗效，并且在过去几十年中得到了广泛应用。内镜止血，包括局部注射肾上腺素、热探头凝固、使用止血夹和/或套扎术，非常有效，总体止血成功率为85%-90%。然而，10%-20%的患者无法通过目前的标准联合治疗治愈。尽管最初止血成功，但复发性溃疡出血也是一个大问题，会导致住院时间延长、死亡率升高和并发症发生率增加，尤其是对于恶性溃疡出血。如何处理所有类型的消化性溃疡出血以及如何预防早期复发性消化性溃疡出血仍然是尚未解决的临床问题。最近，已经开发出了几种新型药物和内镜方法。钾离子竞争性酸阻滞剂已显示出比质子泵抑制剂更强、更持久的抑酸作用。止血粉喷雾和止血凝胶乳剂是有新证据出现的新型止血武器，它们可能是解决问题的关键环节。这篇文献综述将探讨内镜止血的发展以及新型内镜治疗的前景。
