title: Aggressive endoscopic hemostasis for severe gastrointestinal bleeding in critically ill patients to decrease mortality.
abstract: OBJECTIVE
  In critically ill patients, with gastrointestinal (GI) bleeding achieving endoscopic hemostasis has been reported to be often difficult, with a high rebleeding rate. The purpose of this study was to examine the efficacy of endoscopic hemoclipping for severe GI bleeding in critically ill patients.
  
  
  METHODS
  This prospective study was performed at the Department of Traumatology and Critical Care Medicine, Kyorin University Hospital from June 1996 to December 1999. Patients with predefined clinically significant GI bleeding were treated using an established endoscopic hemoclipping protocol that covered indications and procedures.
  
  
  RESULTS
  A total of 1429 patients were enrolled in this study. Of 11 hospitalized cases meeting the definition of severe GI bleeding, it occurred at 12.3 +/- 3.9 days (mean +/- SD) after admission. Initial hemostasis was possible in all patients. Although rebleeding was seen in 1 patient, the permanent hemostasis rate by additional endoscopic hemostasis was 100%. Of the 11, 9 patients were discharged and there were 2 hospital deaths. The direct cause of death depended on the degree of underlying critical illness and combined severe pneumonia. Complications caused by endoscopic hemostasis were not seen in any patient.
  
  
  CONCLUSIONS
  Endoscopic hemostasis is useful in critically ill patients with the severe GI bleeding that occurs during critical care in the intensive care unit.
authors.affiliation: Department of Trauma and Emergency Acute Medicine, Saitama Medical School, 38 Moro Hongo Moroyama Iruma-Gun, Saitama 350-0495, Japan. mnemoto@saitama-med.ac.jp
authors.forename: Manabu
authors.initials: M
authors.lastname: Nemoto
authors.forename: Shoichi
authors.initials: S
authors.lastname: Ohta
authors.forename: Hideaki
authors.initials: H
authors.lastname: Goto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Yukioka
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Matsuda
authors.forename: Shuji
authors.initials: S
authors.lastname: Shimazaki
mesh_terms: D018806:APACHE; D003422:Critical Care; D016558:Hemostasis, Endoscopic; D006801:Humans; D007362:Intensive Care Units; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis