[Emergency endoscopic treatment of digestive hemorrhages of the gastroduodenal tract (Forrest 1a, 1b)].
During the period January 1992 - January 1995, 110 patients affected by digestive hemorrhage of the gastroduodenal tract, at stage Forrest 1a 19 patients (17.3%) and Forrest 1b 91 patients (82.7%), were treated at the Division of Endoscopic Surgery at the "C. Forlanini" Hospital. During the same period 1584 esophagogastroduodenoscopies were performed, the impact on above-mentioned hemorrhages was of 6.95% (110 patients). All hemorrhagic patients were Italians, in 41 (37.2%) the bleeding had a gastric origin, in 69 (62.7%) the origin wa duodenal. The average age was 63 years. In 56 patients there were serious pathologies preexistent to the bleeding: serious respiratory insufficiency, cardiopathies, recent thoracic radical surgery, serious fractures, stay in hospital under intensive care. The urgent hemostasis has been performed with a retractile disposable needle through endoscopy, injecting: adrenaline solution, polidocanolo, alcohol, fibrin glue. The toilet has been made with a hydraulic pump. Relapses have been 10 (9%), more frequent in the stomach: 6 cases, surgical operation has been necessary in 7 cases: 5 cases due to duodenal hemorrhage, 2 cases due to gastric hemorrhage. No complication has been noticed during the endoscopic working. Mortality after operation has been of 57%, correlated to preexistent serious cardio-respiratory conditions. The urgent perendoscopic hemostasis has resulted definitive in 93.6% (103 patients). The reduction in the use of hemotransfusion has been considerable, after the digestive hemorrage, registered in the record of cases; the quality of period in bed, even in serious cases has improved considerably. To conclude the hemostatic method described has shown to be easy, economic, effective.
Cannistrà
F
F
Divisione di Chirurgia Generale, Ospedale C. Forlanini, Roma.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004378:Duodenal Diseases / Q000188:drug therapy* / Q000601:surgery; D004630:Emergencies; D004724:Endoscopy; D016145:Endoscopy, Digestive System; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016558:Hemostasis, Endoscopic; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology; D012720:Severity of Illness Index
D004837:Epinephrine