Endoscopic obliteration for bleeding peptic ulcer

A group of 133 patients treated for bleeding peptic ulcer in our Department, is reviewed. Within several hours of admission, all patients underwent upper gastrointestinal tract gastroscopy and obliteration of the bleeding ulcer. Bleeding gastric ulcers were found in 41 patients, and duodenal ulcers in 92 patients. Patients were classified according to the Forrest scale: IA - 11 patients, IB - 49 patients, IIA - 35 patients, lIB - 40 patients. In 126 (94.7%) patients the bleeding was stopped, and 7 required urgent surgery: 3 patients with gastric ulcer underwent gastrectomy, and 4 with duodenal ulcer - truncal vagotomy with pyloroplasty and had the bleeding site underpinned. Fifty-five patients underwent elective surgery: gastrectomy and vagotomy (18 patients with gastric ulcer), highly selective vagotomy (25 patients with duodenal ulcer) and truncal vagotomy and pyloroplasty (12 patients with duodenal ulcer). None of the patients was observed to have recurrent bleeding.     

Proton-pump inhibitors for acute peptic ulcer bleeding

OBJECTIVE: To review the use of proton-pump inhibitors for acute peptic ulcer bleeding. DATA SOURCES: Articles were obtained through computerized searches of MEDLINE (1966-September 2000). Additionally, several textbooks containing information on the diagnosis and management of acute peptic ulcer bleeding were reviewed. The bibliographies of retrieved publications and textbooks were reviewed for additional references. STUDY SELECTION: All randomized studies and pharmacoeconomic evaluations that used proton-pump inhibitor therapy for acute peptic ulcer bleeding were included. Randomized controlled trials and meta-analyses involving other therapies for treating peptic ulcer bleeding were also reviewed for possible inclusion. DATA EXTRACTION: The primary outcomes extracted from the literature were persistent or recurrent bleeding, transfusion requirements, need for endoscopic intervention or surgery, length of stay, and mortality. DATA SYNTHESIS: Data from double-blind, placebo-controlled trials involving more than 1000 patients demonstrate that short-term, high-dose omeprazole therapy is effective for reducing bleeding and transfusion requirements in patients with acute peptic ulcer bleeding. The patients most likely to benefit from this therapy are hospitalized patients at high risk for rebleeding and patients in whom endoscopic evaluation must be delayed or is unavailable. CONCLUSIONS: Omeprazole (and likely other proton-pump inhibitors) is useful in reducing bleeding and transfusion requirements in patients with acute peptic ulcer bleeding, although better delineation of appropriate candidates is needed.     

Endoscopic band ligation for treatment of non-variceal upper gastrointestinal bleeding.

An endoscopic band ligation method was successful in achieving hemostasis in two patients who had severe coagulopathy and profuse gastrointestinal bleeding from a visible vessel in the stomach. Bleeding was not controlled by multiple epinephrine injections or BICAP electrocoagulation. The technique of band ligation was easy to perform and may provide an alternative treatment for non-variceal upper gastrointestinal bleeding in selected cases.     

Endoscopic band ligation as salvage therapy in patients with bleeding peptic ulcers not responding to injection therapy

BACKGROUND AND STUDY AIM: Endoscopic band ligation has recently been used to control bleeding from a variety of nonvariceal upper gastrointestinal sources. However, it has not been used as salvage therapy in patients with peptic ulcer in whom injection therapy has failed to control bleeding. The objective was to study the role of band ligation in patients with bleeding peptic ulcer where injection therapy had failed. PATIENTS AND METHODS: Endoscopic band ligation was attempted in patients with upper gastrointestinal bleeding from peptic ulcers in whom at least two attempts to control bleeding by injection therapy failed. Anti- Helicobacter pylori therapy was given to patients who were infected with the bacteria. RESULTS: Endoscopic band ligation could be performed in all the 11 patients in whom it was attempted. It was successful in controlling the bleeding in all patients. Over a mean (SD) follow-up of 23.1 (14.8) months none of the patients had recurrence of ulcer or bleeding. CONCLUSIONS: Endoscopic band ligation is an effective means of controlling bleeding in patients with bleeding peptic ulcer in whom injection therapy is not successful. Band ligation followed by anti- H. pylori therapy is useful in preventing recurrence of ulcer and bleeding in such patients.     

Endoscopic therapy for severe ulcer bleeding

Upper gastrointestinal (UGI) bleeding secondary to ulcer disease occurs commonly and results in significant patient morbidity and medical expense. After initial resuscitation, carefully performed endoscopy provides an accurate diagnosis of the source of the UGI hemorrhage and can reliably identify those high-risk subgroups that may benefit most from endoscopic hemostasis. Effective endoscopic hemostasis of ulcer bleeding can significantly improve outcomes by reducing rebleeding, transfusion requirement, and need for surgery, as well as reduce the cost of medical care. This article discusses the important aspects of the diagnosis and treatment of bleeding from ulcers, with a focus on endoscopic therapy.     

消化性溃疡出血内镜治疗的临床价值

目的探讨经内镜治疗消化性溃疡出血的临床价值。方法对2004年1月～2006年1月76例经内镜治疗的消化性溃疡出血患者的临床资料进行回顾性分析。结果76例患者止血成功70例，初次治疗成功率为92．1％（70／76）。再出血6例，再次内镜下止血4例成功，2例治疗无效转外科手术治疗，总有效率为97．3％（74／76）。结论内镜治疗消化性溃疡出血是一种安全、有效的方法，应该作为首选方法在临床上推广应用。     

内镜下消化性溃疡并出血治疗的临床分析

目的探讨内镜下治疗消化性溃疡并出血的治疗效果及价值。方法对46例消化性溃疡并出血急诊内镜检查Forrest分级为Ⅰ级及Ⅱ级患者，初次均行内镜下局部注射1：10000肾上腺素盐水止血治疗，24h内再出血患者予再次注射治疗并联合电凝或止血夹治疗。结果46例患者初次内镜下治疗均立即止血，24h内再出血6例，再次内镜下治疗3例失败转外科手术治疗。初次止血率为86．9％，总止血率为93．5％。结论内镜下止血治疗对消化性溃疡并出血疗效肯定，安全，提高了内科治疗效果，减少了外科手术率。