上消化道出血急诊内镜检查158例

１材料和方法我院内镜室１９９３０３／１９９８０３急诊内镜检查上消化道出血１５８例，其中男１２０例，女３８例，年龄１４岁～８１岁．以黑便受检者１１２例，呕血兼黑便者２６例，单纯呕血者２０例．发病前有消化道症状及病史者１４０例，以上消化道出血为首发症...     

上消化道出血的内镜治疗进展

上消化道出血是指屈氏韧带以上的肠、胃、食管出血，为临床急症，成人年发病率为１５０／１０万人．在上消化道出血患者中约１０％为持续出血或复发出血，其死亡率高达４０％［１］．近年来，上消化道出血的临床研究有了长足的发展，特别是内镜技术的普及和各种内镜下止血...     

上消化道出血急诊内镜检查50例

上消化道出血急诊内镜检查５０例杨智郭美荣内蒙古东胜市人民医院内科０１７０００ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＧａｓｔｒｏｉｎｔｅｓｔｉｎａｌｈｅｍｏｒｈａｇｅ／ｄｉａｇｎｏｓｉｓ主题词胃肠出血／诊断中国图书资料分类号Ｒ５７３２１对象和方法１．１对...     

上消化道出血45例电子小肠镜诊断

上消化道出血４５例电子小肠镜诊断闫晋康１鲍昭芳２１山西省孝义市人民医院内一科０３２３００２上海第二医科大学附属瑞金医院消化科２０００２５ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＧａｓｔｒｏｉｎｔｅｓｔｉｎａｌｈｅｍｏｒｈａｇｅ／ｄｉａｇｎｏｓｉｓＥｎｄｏｓ...     

急诊内镜对上消化道出血的诊治价值

目的评价急诊内镜对诊断上消化道出血病因和部位及其治疗的价值．方法本组164例，男113例，女51例。年龄17岁～71岁（平均46．2岁±13．7岁）．对镜下出血者，局部喷洒10％孟氏液20mL～40mL，对食管胃底静脉曲张破裂出血者，局部喷洒凝血酶，并用5％鱼肝油酸钠作硬化治疗．结果本组内镜下明确诊断148例（90．0％），其中消化性溃疡84例（50％），胃粘膜病变44例（27％），恶性肿瘤16例（10％），食管胃底静脉破裂出血4例（3％），原因不明16例（10％）．出血24h内行内镜检查114例，113例（99％）明确诊断；出血超过24h行内镜检查50例；35例（70％）明确诊断．两者有显著差异（P＜0．01）．本组16例原因不明者未行止血，有4例食管胃底静脉破裂出血和1例十二指肠球部溃疡局部止血效果不佳，余143例止血效果良好，观察大便隐血试验转阴，总有效率96．6％．结论急诊内镜检查对确诊上消化道出血部位、病因及其治疗有重要价值，检查时间越早确诊率越高．早期内镜检查、治疗可降低死亡率．     

儿童上消化道出血30例内镜检查

儿童上消化道出血３０例内镜检查卢美全１李兆申２许国铭２耿振兴２１湖南省江永县人民医院内科４２５４００２第二军医大学附属长海医院消化内科主题词胃肠出血内窥镜检查消化性溃疡出血Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｇａｓｔｒｏｉｎｔｅｓｔｉｎａｌｈｅｍｅｒｒｈ...     

1000例上消化道出血的内镜检查

目的利用内镜了解上消化道出血的主要病因组成．方法对1000例因上消化道出血入院的患者，在距首次出血72h以内进行内镜检查．男603例，女397例，年龄16岁～87岁，平均年龄40．9岁．部分病例诊断经手术或内镜活检后确诊．所有患者均作Hp检测．结果食管癌14例，食管炎10例，食管溃疡8例；食管静脉曲张破裂52例，责门粘膜撕裂症11例胃溃疡189例，胃癌102例，胃炎91例，出血性胃炎50例，残胃炎25例，胃异位胰腺2例，胃底血管畸形5例，吻合口溃疡1且例十二指肠溃疡227例，复合性溃疡45例，出血性十二指肠炎31例，肠蛔虫症7例，十二指肠憩室5例，十二指肠脉瘤样息肉6例，荨麻诊6例，肝胆胰疾病17例（胰头癌3例，胆管胆囊结石8例，肝癌4例，肝脓疡2例）．不明69例．镜检阳性率93．1％．Hp阳性率62．1％．结论出血病因依次为：十二指肠溃疡、胃溃疡、胃炎（慢性胃炎、出血性胃炎）胃癌、食管静脉曲张破裂、其他．消化性溃疡为出血首位病因．     

急诊内镜在急性非静脉曲张性上消化道出血中的诊疗价值

急性非静脉曲张性上消化道出血（ANVUGIB）是临床常见急症之一,随着内镜技术的普及,急诊内镜已成为ANVUGIB的首选诊治方法。目的：探讨急诊内镜在ANVUGIB中的诊疗价值。方法：连续纳入2008年1月～2010年7月上海仁济医院确诊的ANVUGIB患者215例．回顾性分析患者的临床资料,比较急诊内镜组（出血48h内行胃镜检查）和择期内镜组（〉48h行胃镜检查）的ANVUGIB病因检出率以及急诊内镜治疗组和内科保守治疗组的止血有效率、再出血率和手术率。结果：消化性溃疡、消化道肿瘤和糜烂出血性胃炎是本组ANVUGIB患者的三大病因,以消化性溃疡最为常见。急诊内镜组的病因检出率显著高于择期内镜组（P〈0．05）;急诊内镜治疗组的止血有效率显著高于内科保守治疗组．再出血率和手术率显著低于内科保守治疗组（P〈0．05）。结论：对ANVUGIB患者,急诊内镜是迅速安全、疗效确切的诊疗方法,值得在临床推广应用。     

上消化道出血急诊内镜检查88例临床分析

1 资料与方法 1.1 一般资料选择2005年3月-2007年9月我院内镜室急诊内镜检查上消化道出血88例,其中男54例,女34例,年龄14～76岁.黑便52例,呕血兼黑便26例,单纯呕血10例.病前有消化道症状及病史者52例,以上消化道出血为首发症状者36例.88例患者均意识清楚,检查前无明显腹胀及大量呕血.     

上消化道出血内镜检查567例分析

为提高急性上消化道出血的诊治水平,我们对因上消化道出血进行急诊内镜检查的４６９例患者资料进行分析,并与同期出血４８小时以后进行内镜检查的９８例资料进行比较,现报告如下。１．临床资料：本组男４２５例,女１４２例,年龄１５～７４岁,平均４２岁。其中黑便２...     

Time to endoscopy and outcomes in upper gastrointestinal bleeding

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a common problem associated with significant morbidity and mortality. Previous studies show that immediate endoscopies do not affect outcomes in patients; however, endoscopic interventions have evolved. The present retrospective review of endoscopies performed at a large teaching hospital assessed the timing of endoscopy with respect to the morbidity and mortality of UGIB.

METHODS

Diagnostic billing codes were used to assess all inpatients of gastroenterologists at the University Hospital of the London Health Sciences Centre, London, Ontario, from July 2004 to June 2006, using a centralized data recording system. Time to endoscopy (within 6 h, 6 h to 24 h and beyond 24 h) were compared for the outcomes of mortality, need for surgery and transfusion requirements.

RESULTS

From July 2004 to June 2006, there were 502 upper endoscopies performed for the indication of suspected UGIB and 375 for overt acute nonvariceal UGIB. Approximately 10% of cases revealed variceal bleeding. When comparing endoscopy within 6 h with endoscopy at 6 h to 24 h, there were no significant differences in mortality, need for surgery (OR 3.6 and 2.8, respectively, compared with endoscopy beyond 24 h) or transfusion requirements. Even when assessing the group that received endoscopic hemostasis, time to endoscopy was not associated with better outcomes. Multivariate analysis did not demonstrate any advantages for early endoscopy (less than 6 h) compared with endoscopy within 24 h.

CONCLUSIONS

Most patients with acute gastrointestinal bleeding can be effectively managed with endoscopy within 24 h.     

胶囊内镜在老年人不明原因消化道出血中的应用价值

目的 通过分析老年不明原因消化道出血(PGIB)患者的临床资料和胶囊内镜检查结果,探讨胶囊内镜在老年OGIB患者中的应用价值. 方法 分析比较2002年5月至2007年2月,因OGIB在我院行胶囊内镜检查的老年患者及非老年患者的一般资料、出血类型及检查结果.老年组97例,男性40例、女性57例,平均年龄(70.8±6.8)岁;非老年组99例,男性61例、女性38例,平均年龄(44.4±10.3)岁. 结果 老年组显性出血89例,隐性出血8例;非老年组分别为91例和8例.两组胃排空时间、全小肠检查完成率及胶囊延迟率,差异均无统计学意义,老年组小肠转运时间较非老年组显著延长(P<0.05).老年组2例因胶囊内镜滞留于食管未纳入诊断统计,老年组获阳性诊断62例(65.3%),血管病变为最常见病因;非老年组获阳性诊断67例(67.7%).小肠克罗恩病为最常见病因.两组获得阳性诊断率差异无统计学意义,阳性诊断构成比差异有统计学意义(P<0.01).老年组未发现并发症. 结论 胶囊内镜检查对老年OGIB患者是一项安全有效的检查手段,血管病变为老年OGIB患者最常见的病因.     

Comparison of urgent and early endoscopy for acute non-variceal upper gastrointestinal bleeding in high-risk patients

ObjectiveData regarding early (within 24 h) and urgent endoscopy (within 12 h) in non-variceal upper gastrointestinal bleeding (NV-UGIB) revealed conflicting results. This study aimed to investigate the impact of endoscopy timing on the outcomes of high-risk patients with NV-UGIB.Patients and methodsFrom February 2020 to February 2021, consecutive high-risk (Glasgow–Blatchford score ≥12) adults admitted to the emergency department with NV-UGIB were analyzed retrospectively. The primary composite outcome was 30-day mortality from any cause, inpatient rebleeding, need for endoscopic re-intervention, need for surgery or angiographic embolization.Results240 patients were enrolled: 152 (63%) patients underwent urgent endoscopy (<12 h) and 88 (37%) patients underwent early endoscopy (12–24 h). One or more components of the composite outcome were observed in 53 (22.1%) patients: 30 (12.5%) had 30-day mortality, rebleeding occurred in 27 (11.3%), 7 (2.9%) underwent endoscopic re-intervention, and 5 (2.1%) required surgery or angiographic embolization. The composite outcome was similar between the groups. Multivariate analysis showed only hemodynamic instability on admission (OR: 3.05, p = 0.006), and the previous history of cancer (OR: 2.42, p = 0.029) were significant in predicting composite outcome. In terms of secondary outcomes, the endoscopic intervention was higher in the urgent endoscopy group (p = 0.006), whereas the number of transfused erythrocyte suspensions and the length of hospital stay was higher in the early endoscopy group (p = 0.002 and p = 0.040, respectively).ConclusionsUrgent endoscopy leads to a significant reduction in the length of hospitalization and the number of transfused erythrocyte suspensions in NV-UGIB, which can contribute to patient satisfaction, reduce healthcare expenditure, and improve hospital bed availability. The composite outcome and its sub-outcomes were the same among both groups.     

Endoscopic difficulties in the diagnosis of upper gastrointestinal bleeding

INTRODUCTION Bleeding from the upper gastrointestinal ( GI ) tract remains common ,with a reported annual incidence of up to 172 per 100 000 [1],which has of anything increased from earlier series. Case fatality was recently reported as 14%[2] ,which has probably not changed over several decades .These figures may reflect a rising proportion of elderly patients and increasing non 杝teroidal anti-inflammatory use ,but occur despite apparently better treatments and understanding of the underlying pathophysiology of peptic ulcer disease.     

上消化道平滑肌肿瘤内镜诊治

目的总结上消化道平滑肌肿瘤发病情况及其内镜特点，探讨其良、恶性病变的诊治方法。方法对２５年间经手术和病理证实的１５６例上消化道平滑肌肿瘤进行回顾性分析。结果１５６例上消化道平滑肌肿瘤中平滑肌瘤１２６例，平滑肌肉瘤３０例，内镜确诊率８１．４％。食管平滑肌瘤较多见，且多为≤２　ｃｍ的小平滑肌瘤（７８．２％）；７３．３％的平滑肌肉瘤表面有溃疡形成，而平滑肌瘤表面溃疡仅为１４．３％，两者差异显著（Ｐ＜０．０１）；肿瘤长径≤２　ｃｍ者７５．４％为平滑肌瘤，＞　５　ｃｍ者７６．７％为平滑肌肉瘤。９５例直径≤　２　ｃｍ的平滑肌瘤经内镜推顶圈套法切除，无严重并发症发生。结论食管小平滑肌瘤较多见；肿瘤大小及表面溃疡为内镜下鉴别平滑肌瘤与肉瘤的重要依据；内镜下推顶圈套法切除直径≤　２　ｃｍ的平滑肌瘤安全、有效。     

Hemostatic sprays to control active nonvariceal upper gastrointestinal bleeding

As nonvariceal upper gastrointestinal bleeding remains a critical health concern, there is a need for ongoing optimization of endoscopic hemostasis modalities. Current methods for endoscopic hemostasis include epinephrine injection, thermal coagulation, and mechanical clips. Although these modalities have proven efficacy, there are limitations to their use, including significant learning curves and the requirement of expert assistants. Moreover, there still remains an ongoing risk of rebleeding after therapy. Therefore, a need exists for a safe and easy-to-use method for endoscopic hemostasis, specifically in the setting where current methods for hemostasis are limited or in the setting when hemostasis has not been achieved despite their application. Hemostatic sprays have emerged as novel methods for achieving hemostasis. Therefore, we sought to appraise the evidence concerning the use of hemostatic sprays. Our review highlights that hemostatic spray is a safe and effective method for endoscopic hemostasis, specifically, when current methods are infeasible, unsuccessful, and in malignant nonvariceal upper gastrointestinal bleeding.     

Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

AIM： To investigate acute nonvariceal bleeding in the upper gastrointestinal （GI） tract and evaluate the effects of endoscopic hemoclipping. METHODS： Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS： The 68 cases （male：female = 42：26, age from 9 to 70 years, average 54.4） presented with hernatemesis in 26 cases （38.2%）, melena in nine cases （13.3%）, and both in 33 cases （48.5%）. The causes of the bleeding included gastric ulcer （29 cases）, duodenal ulcer （11 cases）, Dieulafoy＇s lesion （11 cases）, Mallory-Weiss syndrome （six cases）, post-operative （three cases）, post-polypectomy bleeding （five cases）, and post-sphincterotomy bleeding （three cases）; 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery （three cases had peptic ulcers, one had Dieulafoy＇s lesion, and two were caused by sphincterotomy）; three patients died （two had Dieulafoy＇s lesion and one was caused by sphincterotomy）; and one had recurrent bleeding with Dieulafoy＇s lesion 10 mo later, but in a different location. CONCLUSION： Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.     

胶囊内镜在老年人不明原因的消化道出血诊断中的应用

目的探讨M2A胶囊内镜对老年人不明原因的消化道出血的诊断作用。方法对27例不明原因消化道出血的老年患者进行M2A胶囊内镜检查，其中22例经过电子胃镜、结肠镜或小肠气钡双重造影检查，均未明确出血部位；另5例未做过任何检查。结果27例患者中，经M2A胶囊内镜检查发现出血病变20例，检出率为74．1％。检出病变主要为空肠血管发育不良6例，小肠多发息肉4例（其中1例为罕见的Cronkhite-Canada综合征），小肠占位性病变4例，小肠黏膜溃疡7例，小肠黏膜糜烂9例，小肠憩室1例，胃内小动脉出血2例，胃内黏膜糜烂、溃疡5例。有12例患者同时伴有2处或以上的病变。结论M2A胶囊内镜对不明原因的消化道出血部位有较高的检出率，是一种非侵人性的检查方法，尤其适用于老年患者。     

A pilot study of single-use endoscopy in screening acute gastrointestinal bleeding

AIM:To investigate the feasibility of a single-use endoscopy as an alternative procedure to nasogastric lavage in patients with acute gastrointestinal(GI) bleeding.METHODS:Patients who presented with hematemesis,melena or hematochezia were enrolled in this study.EG scan and conventional esophagogastroduodenoscopy(EGD) were subsequently performed.Active bleeding was defined as blood in the stomach,and inactive bleeding was defined as coffee ground clots and clear fluid in the stomach.The findings were recorded and compared.RESULTS:Between January and March,2011,13 patients that presented with hematemesis(n = 4),melena(n = 6),or bleeding from a previous nasogastric feeding tube(n = 3),were enrolled in this study.In 12 patients with upper GI bleeding,the EG scan device revealed that 7 patients had active bleeding and 5 patients had inactive bleeding,whereas conventional EGD revealed that 8 patients had active bleeding and 4 patients had inactive bleeding.The sensitivity and specificity of the EG scan device was 87.5% and 100% for active bleeding,with conventional EGD serving as a reference.No complication were reported during the EG scan procedures.CONCLUSION:The EG scan is a feasible device for screening acute upper GI bleeding.It may replace nasogastric lavage for the evaluation of acute upper GI bleeding.     

Comparison of a novel bedside portable endoscopy device with nasogastric aspiration for identifying upper gastrointestinal bleeding

AIM: To compare outcomes using the novel portable endoscopy with that of nasogastric (NG) aspiration in patients with gastrointestinal bleeding.METHODS: Patients who underwent NG aspiration for the evaluation of upper gastrointestinal (UGI) bleeding were eligible for the study. After NG aspiration, we performed the portable endoscopy to identify bleeding evidence in the UGI tract. Then, all patients underwent conventional esophagogastroduodenoscopy as the gold-standard test. The sensitivity, specificity, and accuracy of the portable endoscopy for confirming UGI bleeding were compared with those of NG aspiration.RESULTS: In total, 129 patients who had GI bleeding signs or symptoms were included in the study (age 64.46 ± 13.79, 91 males). The UGI tract (esophagus, stomach, and duodenum) was the most common site of bleeding (81, 62.8%) and the cause of bleeding was not identified in 12 patients (9.3%). Specificity for identifying UGI bleeding was higher with the portable endoscopy than NG aspiration (85.4% vs 68.8%, P = 0.008) while accuracy was comparable. The accuracy of the portable endoscopy was significantly higher than that of NG in the subgroup analysis of patients with esophageal bleeding (88.2% vs 75%, P = 0.004). Food material could be detected more readily by the portable endoscopy than NG tube aspiration (20.9% vs 9.3%, P = 0.014). No serious adverse effect was observed during the portable endoscopy.CONCLUSION: The portable endoscopy was not superior to NG aspiration for confirming UGI bleeding site. However, this novel portable endoscopy device might provide a benefit over NG aspiration in patients with esophageal bleeding.