[Endoscopic control of hemorrhage in the upper part of the digestive tract using hemostatic clips].
One of the endoscopy methods to stop upper gastrointestinal tract (GIT) bleeding in the limelight these days is hemostasis using metal clips. This method is indicated especially in patients with bleeding from an eroded artery and in patients where other hemostatic methods proved to be unsuccessful. Goal of our work was to assess successfulness of hemostasis, percentage of early rebleedings, and lethality of patients managed with this method. At the same time we present indications and locations of bleedings in these patients. We have retrospectively evaluated a group of 75 patients indicated for urgent endoscopy for GIT bleeding in a period from August 2000 till the end of February 2002. An average age of these patients was 69.7 years. We haven't managed to stop bleeding in 2 cases. In 12 patients (15.1%) rebleeding appeared within two days following intervention. From all the patients with early rebleeding: 4 patients had an ulcer and an eroded artery in stomach (4 died from bleeding, one of them undergone a surgery), 4 patients had an ulcer in duodenal bulb with artery at base (3 undergone surgery, 1 died), three patients had esophageal bleeding, and one patient had bleeding from the suture in stomach wall (undergone surgery and died). In majority of cases (82.8%) patients were managed with a combined technique (clip + adrenaline injection). With regard to a location of lesions treated with clip application, following locations were treated: esophagus 9.5%, stomach 40.5%, pylori channel 2.7%, duodenal bulb 39.2%, gastroenteroanastomosis 4.1%, D2 4.1%. Bleeding in 76% of patients was from an ulcer and artery (Forrest Ia, IIa). Results confirmed high effectiveness of hemostatic clips in primary hemostasis of GIT bleeding--in our sample more than 95%. An early rebleeding appeared in 15% of patients. Results presented correspond with data presented in world literature.
St'ovícek
J
J
Interní klinika 2. lékarské fakulty UK a FN, Praha.
Keil
R
R
Buresová
M
M
Golánová
J
J
Hrdlicka
L
L
D000368:Aged; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D012008:Recurrence; D013525:Surgical Instruments