[Endoscopic treatment of bleeding ulcers: has everything been said and done?].
Endoscopic treatment reduces bleeding recurrence, the need for surgery and mortality in patients with bleeding ulcers. However endoscopic treatment fails in 10-15% of patients, leading to high morbidity and mortality. The therapeutic measures with demonstrated effectiveness in reducing the risk of hemorrhagic recurrence and its complications are combined endoscopic treatment (adrenaline plus a second hemostatic intervention) and proton pump inhibitors. Also useful, although there is less evidence, are immediate resuscitation and <<second look>> endoscopy. Some studies suggest that activated recombinant factor VII infusion or supra-selective arterial embolization can be useful in severe hemorrhage. Further studies are required to determine optimal treatment according to the characteristics of each patient.
Calvet
X
X
Unitat de Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España. xcalvet@cspt.es
Vergara
M
M
Brullet
E
E
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D019090:Case Management; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004384:Duodenoscopy; D004837:Epinephrine / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005167:Factor VII / Q000627:therapeutic use; D015942:Factor VIIa; D005544:Forecasting; D005773:Gastroscopy; D006801:Humans; D015201:Meta-Analysis as Topic; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy / Q000601:surgery*; D054328:Proton Pump Inhibitors; D011994:Recombinant Proteins / Q000627:therapeutic use; D012008:Recurrence; D012151:Resuscitation; D024162:Second-Look Surgery
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa; D004837:Epinephrine