title: Hemostasis with endoscopic hemoclipping for severe gastrointestinal bleeding in critically ill patients.
abstract: OBJECTIVE
  The fact that endoscopic hemostasis is difficult to achieve and that the rebleeding rate is high in critically ill patients with gastrointestinal bleeding has often been reported. The purpose of this study was to examine the efficacy of endoscopic hemoclipping for gastrointestinal bleeding from ulcers and gastrointestinal lesions associated with critical illnesses.
  
  
  METHODS
  Critically ill patients who were treated in a university hospital were studied prospectively. For patients with predefined clinically significant gastrointestinal bleeding, an established protocol of endoscopic hemoclipping (including indications and procedures) was used.
  
  
  RESULTS
  Ten of 885 patients were treated according to this protocol. All suffered circulatory collapse, and respiratory management required intubation. The initial rate of hemostasis was 100%, and no rebleeding was observed. The APACHE III scores at 24 h after hemostasis were reduced, relative to the time of bleeding (p < 0.01).
  
  
  CONCLUSIONS
  Endoscopic hemoclipping is useful in achieving hemostasis in critically ill patients with severe gastrointestinal bleeding.
authors.affiliation: Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ohta
authors.forename: T
authors.initials: T
authors.lastname: Yukioka
authors.forename: S
authors.initials: S
authors.lastname: Ohta
authors.forename: Y
authors.initials: Y
authors.lastname: Miyagatani
authors.forename: H
authors.initials: H
authors.lastname: Matsuda
authors.forename: S
authors.initials: S
authors.lastname: Shimazaki
mesh_terms: D018806:APACHE; D016638:Critical Illness; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D012008:Recurrence; D013312:Stress, Physiological / Q000150:complications; D013997:Time Factors