Kohler B, Riemann J F
Medical Clinic C, Municipal Hospital Ludwigshafen/Rhein, Germany.
Endoscopy. 1993 Mar;25(3):219-23. doi: 10.1055/s-2007-1010296.
Endoscopic Doppler ultrasound enables the reliable identification of vessels in the base of gastroduodenal ulcers. In a prospective study including 114 patients with acute ulcer bleeding, pulsed Doppler ultrasound was able to demonstrate superficial blood vessels in the ulcer base in 62% of 106 cases where complete Doppler assessment was possible (93%). Agreement between the endoscopic pattern of visible vessels and the Doppler ultrasound findings was attained in only 52% of the cases. Doppler positive ulcers (n = 66) were treated with injection therapy (if necessary, repeated), irrespective of their Forrest classification. Using such an approach, the rebleeding rate in this group decreased to less than 8% and none of the patients died of causes related to the hemorrhage. All Doppler negative ulcers (n = 40) healed without complications or the need for endoscopic treatment; among these were 11 cases with Forrest IIa and b. We conclude that endoscopic Doppler appears to be a valuable diagnostic procedure in the assessment of bleeding ulcers, thus modifying the Forrest classification. Our concept is that Doppler positive ulcers require local endoscopic treatment, whereas Doppler negative ulcers can be treated conservatively.
内镜多普勒超声能够可靠地识别胃十二指肠溃疡底部的血管。在一项纳入114例急性溃疡出血患者的前瞻性研究中，在106例能够进行完整多普勒评估的病例中（93%），脉冲多普勒超声在62%的病例中显示出溃疡底部的浅表血管。仅52%的病例中可见血管的内镜表现与多普勒超声检查结果一致。多普勒阳性溃疡（n = 66）无论其福里斯特分类如何，均接受注射治疗（必要时重复）。采用这种方法，该组再出血率降至8%以下，且无患者死于与出血相关的原因。所有多普勒阴性溃疡（n = 40）均愈合，无并发症，也无需内镜治疗；其中有11例福里斯特IIa和IIb级溃疡。我们得出结论，内镜多普勒在评估出血性溃疡方面似乎是一种有价值的诊断方法，从而对福里斯特分类进行了修正。我们的观点是，多普勒阳性溃疡需要局部内镜治疗，而多普勒阴性溃疡可以保守治疗。
