title: Evaluation of the effectiveness of methods of endoscopic treatment of bleeding from the duodenal mucosa.
abstract: Bleeding from the upper gastrointestinal tract, despite the prevalence of endoscopic examinations and endoscopic methods of bleeding control, remains a significant problem. Available data indicate nondecreasing mortality of patients with active bleeding from the upper gastrointestinal tract although it is commonly known that such patients require fast endoscopic diagnosis and urgent treatment. Currently, the choice of method of endoscopic treatment of bleeding depends mostly on its availability and the decision of the physician performing the procedure.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the efficacy of different techniques of endoscopic hemostasis from the duodenum, mainly the comparison of monotherapy with the use of at least two techniques of endoscopic treatment of bleeding used simultaneously.
  
  
  METHODS
  This paper presents a retrospective analysis of medical records of 78 patients (27 women, 51 men; 33 of them were over 65 years), hospitalized in the Department of Nephrology, Hypertension and Family Medicine between 2009 and 2012. In all these patients, active bleeding from the duodenum was observed during endoscopy performed because of clinical signs of gastrointestinal bleeding, and the following methods of blood flow stemming were applied: injection with a solution of adrenaline alone or in combination with placement of clips.
  
  
  RESULTS
  The use of haemostatic clips alone or in a combination with injections of adrenaline around the bleeding site was demonstrated to be the most effective method of endoscopic control of bleeding from the duodenum. Injections of epinephrine around the bleeding site as monotherapy turned out to be the least effective method.
  
  
  CONCLUSIONS
  The most effective method of endoscopic control of bleeding from duodenal ulcers is the use of hemostatic clips alone or preceded by adrenaline injections, while the use of injections of adrenaline around the bleeding vessel was the least effective method.
authors.affiliation: WAM University Hospital, Medical University of Lodz, Poland: Department of Nephrology, Hypertension and Family Medicine.
authors.forename: Anna
authors.initials: A
authors.lastname: Frątczak
authors.affiliation: WAM University Hospital, Medical University of Lodz, Poland: Department of Nephrology, Hypertension and Family Medicine; Gastrointestinal Endoscopy Laboratory.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kujawski
authors.affiliation: WAM University Hospital, Medical University of Lodz, Poland: Department of Nephrology, Hypertension and Family Medicine.
authors.forename: Anna
authors.initials: A
authors.lastname: Gluba-Brzózka
authors.affiliation: WAM University Hospital, Medical University of Lodz, Poland: Department of Nephrology, Hypertension and Family Medicine.
authors.forename: Jacek
authors.initials: J
authors.lastname: Rysz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004378:Duodenal Diseases / Q000175:diagnosis / Q000628:therapy*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004837:Epinephrine
keywords: adrenaline; bleeding; clip placement; duodenum