Kohler B, Rieman J F
Department of Medicine, Medical Center of the Municipality of Ludwigshafen, Germany.
Hepatogastroenterology. 1994 Feb;41(1):51-3.
The visible vessel in the floor of the ulcer seen on endoscopy is one of the most important prognostic factors of ulcer bleeding. With the ultimate aim of improving the purely visual interpretation of the base of the ulcer, we investigated the utility of an innovative pulsed endoscopic Doppler procedure in 140 patients with acute ulcer bleeding. Agreement between the endoscopic appearance and the Doppler ultrasonographic findings was observed in only 59% of the ulcers. In all Doppler-positive ulcers, injection therapy was performed irrespective of the endoscopic appearance of the ulcer. This was repeated if the ulcer was still Doppler-positive on repeat examination. With this strategy, only 9% recurrent hemorrhages were seen, and there was no hemorrhage-associated mortality. Among the Doppler-negative lesions, which received only medical treatment, no rebleeding was observed. On the basis of these results, it would appear that a Doppler ultrasound oriented classification of ulcer bleeding is superior to the Forrest classification based on a purely visual interpretation. The endoscopic Doppler verifies the visual impression of the ulcer, identifies the indication for operative endoscopy, and can monitor the effectiveness of the latter.
内镜检查时在溃疡底部可见的血管是溃疡出血最重要的预后因素之一。为了最终改善对溃疡底部的单纯视觉判断，我们对140例急性溃疡出血患者进行了一项创新性脉冲内镜多普勒检查的效用研究。仅59%的溃疡在内镜表现与多普勒超声检查结果之间观察到一致性。在所有多普勒检查呈阳性的溃疡中，无论溃疡的内镜表现如何，均进行注射治疗。如果复查时溃疡仍为多普勒阳性，则重复治疗。采用该策略，仅观察到9%的复发性出血，且无出血相关死亡。在仅接受药物治疗的多普勒检查呈阴性的病变中，未观察到再出血。基于这些结果，似乎基于多普勒超声的溃疡出血分类优于基于单纯视觉判断的福里斯特分类。内镜多普勒可验证对溃疡的视觉印象，确定手术内镜检查的适应证，并可监测其有效性。
