title: Efficacy of endoscopic hemoclipping for GI bleeding in relation to severity of shock.
abstract: OBJECTIVE
  To examine the efficacy of prospectively performing endoscopic hemoclipping in patients with severe gastrointestinal bleeding by assessing in relation to the severity of the case.
  
  
  METHODS
  Endoscopic hemoclipping was performed in 44 patients in shock caused by severe gastrointestinal bleeding. The level of severity was categorized using two factors. One factor was the presence or absence of severe shock, and the other was the presence or absence of active bleeding at endoscopy. Age, blood transfusion volume, APACHE III score, coagulopathy, initial hemostatic, rebleeding and mortality rate were recorded in relation to those four subsets. If rebleeding occurred, the systolic blood pressure, heart rate and serum hemoglobin concentration were compared between the initial time of bleeding and rebleeding.
  
  
  RESULTS
  Initial hemostasis was successfully achieved in all cases. The severe shock group required significantly more blood transfusions. The most severe subset had the highest APACHE III score, and coagulopathy. Rebleeding occurred in seven cases in the severe shock group only. In the rebleeding group, the systolic body pressure was lower, heart rate was higher, and serum hemoglobin concentration was lower than the non-rebleeding group. Four patients, all in subset 1, died, but no patient died due to gastrointestinal bleeding.
  
  
  CONCLUSIONS
  The endoscopic hemoclipping method is very effective for severe gastrointestinal bleeding in shock. The severity of shock was a more important risk factor than the presence of active bleeding. Our category of severity is simple, it reflects the patients' clinical condition accurately, and is very useful for patients with gastrointestinal bleeding.
authors.affiliation: Department of Emergency and Critical Care Medicine, Tokyo Medical University, Japan. sho-ohta@tokyo-med.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Ohta
authors.forename: H
authors.initials: H
authors.lastname: Goto
authors.forename: T
authors.initials: T
authors.lastname: Yukioka
authors.forename: S
authors.initials: S
authors.lastname: Mishima
authors.forename: S
authors.initials: S
authors.lastname: Shimazaki
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D005260:Female; D005773:Gastroscopy; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D012771:Shock, Hemorrhagic / Q000601:surgery*; D013276:Stomach Ulcer / Q000401:mortality / Q000601:surgery*; D013312:Stress, Physiological / Q000150:complications; D013525:Surgical Instruments; D015996:Survival Rate