Donahue P E, Mobarhan S, Layden T J, Nyhus L M
Surg Gynecol Obstet. 1984 Aug;159(2):113-8.
It has been difficult to determine the real efficacy of endoscopic treatment for upper gastrointestinal tract bleeding sites for several reasons. First, since 80 per cent of an unselected group are expected to stop bleeding spontaneously, it is important to focus upon those individuals who continue to bleed instead of a group in whom bleeding would have stopped spontaneously in the majority. Second, it is difficult, if not impossible, to have comparable groups of patients with similar lesions and similar rates of bleeding who can be randomized into different treatment groups. This report describes the use of a bipolar endoscopic coagulation device in 28 patients with active massive upper gastrointestinal tract hemorrhage who represent 10 per cent of the patients with hemorrhage during a one year interval. Endoscopic treatment controlled bleeding initially in 23 of these patients. Another eight patients with recent hemorrhage who were at high risk for recurrent bleeding (visible vessels) had endoscopic coagulation without subsequent hemorrhage. Immediate operations were required in five of the 28 and delayed operations in another four. Mortality in the patients treated by endoscopic or surgical therapy was comparable (20 per cent), but no patient died of hemorrhage. The high mortality in this group of patients is explained by associated illnesses. B-C is as effective as other endoscopic treatments for nonvariceal sources of upper gastrointestinal tract hemorrhage. This modality is relatively cheap compared with other devices, is theoretically less complicated and has minimal risk to the individual patient. Because of these considerations, it is a technique which deserves wider application and may become the endoscopic treatment of choice for control of upper gastrointestinal tract hemorrhage. Patients with endoscopic control of upper gastrointestinal tract bleeding avoid perioperative morbidity, have a lower transfusion requirement and may have a shorter hospital stay than comparable individuals who require operative control of bleeding sites.
由于多种原因，一直难以确定内镜治疗上消化道出血部位的实际疗效。首先，由于预计在未经挑选的一组患者中，80%会自行止血，因此重点应放在那些持续出血的个体上，而不是大多数会自行止血的群体。其次，很难（如果不是不可能的话）有病变相似、出血率相似的可比患者组，并将其随机分为不同的治疗组。本报告描述了在28例活动性大量上消化道出血患者中使用双极内镜凝血装置的情况，这些患者占一年期间出血患者的10%。内镜治疗最初使其中23例患者的出血得到控制。另外8例近期出血且有再出血高风险（可见血管）的患者接受了内镜凝血，随后未再出血。28例患者中有5例需要立即手术，另外4例需要延迟手术。接受内镜或手术治疗的患者死亡率相当（20%），但没有患者死于出血。这组患者的高死亡率是由相关疾病导致的。对于上消化道非静脉曲张性出血来源，B - C与其他内镜治疗方法一样有效。与其他设备相比，这种方式相对便宜，理论上并发症较少，对个体患者的风险最小。基于这些考虑，它是一种值得更广泛应用的技术，可能会成为控制上消化道出血的内镜治疗首选方法。与需要手术控制出血部位的类似患者相比，内镜控制上消化道出血的患者避免了围手术期发病，输血需求较低，住院时间可能更短。
