[Endoscopy in non-variceal upper gastrointestinal bleeding].
Non variceal upper gastrointestinal bleeding (NVUGIB) still is a common cause of hospital admissions, morbidity and a significant mortality. A decrease trend has recently been documented thank to the general use of therapeutic endoscopy in spite of a greater use of non steroidal antinflamatory agents (NSAID) and a growing senile population. Most of NVUGIB are caused by peptic ulcer (PU) and usually stop spontaneously, but 15% of cases need endoscopic or surgical intervention. Clinically these patients can be identified by the presence of shock, orthostatic hypotension or associated organ failures (Rockall scale) and by endoscopic findings of active bleeding or non bleeding visible vessel (Forrest scale) both useful and complimentary. There are diverse endoscopic techniques to halt NVUGIB, with transendoscopic saline injection with or w/o epinephrine + coaptive bipolar electrocoagulation or heater probe being the gold standard with 85 to 90% initial success, and furthermore stopping recurrences in similar figures. Under these circumstances new methods as argon plasma electrocoagulation or mechanic methods such as endoclips or banding have difficulty to demonstrate their usefulness when compared to established procedures, but still may have some indications such as diffuse gastric or vascular lesions for argon plasma electrocoagulation, and bands or endoclips for deep ulcers given their lower risk of perforation. Antisecretory agents are useful complementary treatment decreasing recurrence by 8% when used at high doses. Hp eradication decreases PU and NVUGIB recurrence, except in patients who ingest NSAID on a regular basis who require nocturnal antisecretory treatment.
Ballesteros Amozurrutia
Mario Arturo
MA
Gastroenterólogo, Hospital Angeles del Pedregal, Mexico, D.F.
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D004381:Duodenal Ulcer / Q000150:complications; D004564:Electrocoagulation / Q000379:methods; D004837:Epinephrine / Q000008:administration & dosage; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008309:Mallory-Weiss Syndrome / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D012965:Sodium Chloride / Q000008:administration & dosage; D013566:Sympathomimetics / Q000008:administration & dosage
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D013566:Sympathomimetics; D012965:Sodium Chloride; D004837:Epinephrine