Kapetanakis A M, Kyprizlis E P, Tsikrikas T S
Division of Gastroenterology, General Hospital of Larissa, Greece.
Hepatogastroenterology. 1997 Jan-Feb;44(13):288-93.
BACKGROUND/AIMS: Although therapeutic endoscopy is regarded as the procedure of choice for bleeding ulcers, the disease mortality is barely altered. The aim of the present study was to evaluate the efficacy of repeated therapeutic endoscopy in patients with bleeding ulcer.
From January 1990 to April 1995, 727 patients with bleeding ulcers were admitted to hospital under the care of one gastroenterologist who endoscoped every patient within 18 hours of admission. Epinephrine (1:10,000) was injected into the lesions of patients found to have active bleeding, a non-bleeding visible vessel, or adherent red clot. After the initial diagnostic-therapeutic procedure, all patients admitted from 1990-92 (group A) were treated conservatively, and referred for operation if re-bleeding was uncontrolled. Patients admitted from 1993 to April 1995 (group B) were treated aggressively with re-endoscopy one day later, and repeat hemostasis if re-bleeding was evident. During hospitalization, diagnostic/therapeutic endoscopy was then repeated if re-bleeding was diagnosed by either a fall in hematocrit of > 3%, or on clinical criteria. Patients were transfused if the hematocrit fell to < 30%.
Repeated hemostasis was needed in 30 group B patients; one patient requiring 7 therapeutic endoscopies. The outcome of patients in group B was better than group A, with fewer emergency operations (3 vs 10) (p < 0.05) and deaths (0 vs 4) (p < 0.05), while no difference was seen in transfusion requirements (4.1 vs 3.9 units) (p > 0.1), or in length of hospital stay (6.8 vs 7.1 days) (p > 0.1).
Repeated diagnostic/therapeutic endoscopy benefits patients with bleeding ulcers.
背景/目的：尽管治疗性内镜检查被视为出血性溃疡的首选治疗方法，但该病的死亡率几乎没有改变。本研究的目的是评估重复治疗性内镜检查对出血性溃疡患者的疗效。
1990年1月至1995年4月，727例出血性溃疡患者在一位胃肠病学家的照料下入院，该医生在患者入院后18小时内对每位患者进行了内镜检查。对于发现有活动性出血、非出血性可见血管或附着的红色血凝块的患者，将肾上腺素（1:10,000）注入病变部位。在最初的诊断治疗程序后，1990 - 1992年入院的所有患者（A组）接受保守治疗，如果再出血无法控制则转至手术治疗。1993年至1995年4月入院的患者（B组）在一天后积极接受再次内镜检查，如果再次出血明显则再次止血。在住院期间，如果通过血细胞比容下降> 3%或根据临床标准诊断为再出血，则重复进行诊断/治疗性内镜检查。如果血细胞比容降至< 30%，则对患者进行输血。
B组有30例患者需要重复止血；1例患者需要进行7次治疗性内镜检查。B组患者的结局优于A组，急诊手术较少（3例对10例）（p < 0.05），死亡人数较少（0例对4例）（p < 0.05），而输血需求（4.1单位对3.9单位）（p > 0.1）或住院时间（6.8天对7.1天）（p > 0.1）没有差异。
重复诊断/治疗性内镜检查对出血性溃疡患者有益。
