[Endoscopic hemostasis against hemorrhage from the upper gastrointestinal tract: its indication and limitation].
We reviewed endoscopic hemostasis that had been performed upon 353 acutely hemorrhagic peptic ulcer cases: Among them, 145 received thrombin spraying; 36, electrocoagulation; 145, topical injection of ethanol; and 27, topical injection of aetoxyscrelol. Hemostasis lasting for more than 24 hours after the treatment was defined as transient hemostasis, and hemostasis lasting for more than two weeks, as permanent hemostasis. The overall rate of transient hemostasis was 87.5%; 84.8% by thrombin spraying, 83.4% by electrocoagulation, 89.0% by injection of ethanol, 100% by injection of aetoxyscrelol, respectively. The overall rate of permanent hemostasis was 71.1%; 75.9% by thrombin spraying, 58.3% by electrocoagulation, 69.7% by injection of ethanol, 70.4% by injection of aetoxyscrelol, respectively. The rate of emergency operation for bleeding was reduced to 9.9% after the induction of endoscopic hemostasis from 64.0% before the induction. The mortality was also reduced to 3.1% from 8.9%. Particularly, over the last 4 years, the emergency operation and the mortality have been reduced, accounting from 7.2% and 2.2%, respectively. In conclusions, thrombin spraying is the first choice for mild and diffuse hemorrhage, and topical injection of ethanol is indicated for hemorrhage from exposed vessels and for localized hemorrhage.
Harada
K
K
Second Department of Surgery, Kumamoto University Medical School, Japan.
Misumi
A
A
Mizumoto
S
S
Kiyohara
H
H
Akagi
M
M
Suko
H
H
Yamabe
H
H
D000368:Aged; D004564:Electrocoagulation; D004724:Endoscopy; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use; D013917:Thrombin / Q000627:therapeutic use
D000077423:Polidocanol; D000431:Ethanol; D011092:Polyethylene Glycols; D013917:Thrombin