内镜下注射治疗消化性溃疡出血

目的 探讨内镜下注射止血的临床应用及意义。方法 2001年7月至2002年8月因呕血和（或）黑便入院，经紧急内镜检查确诊为消化性溃疡并出血患者81例，分成内科保守治疗和内镜注射止血治疗二组，内镜组在内科保守治疗的基础上于出血灶注射HLGE液。结果 内镜组42例，止血成功率95.24％，对照组39例，止血成功率79．49％，二组有显著性差异。结论 内镜注射止血治疗简单有效，可降低手术率和再出血率。     

联合应用内镜注射和热凝治疗消化性溃疡出血

目的观察评价内镜注射肾上腺素、热探头热凝治疗和联合上述两种方法治疗消化性溃疡出血的疗效。方法１０２例消化性溃疡出血患者分为三组,其中内镜注射组３７例,热凝治疗组３１例,内镜注射联合热凝治疗组３４例。结果４８小时止血率在三组分别为８６．５％、８７．１％和９７．１％。一周内再出血率分别为１３．５％、９．７％和８．８％,手术率为１６．２％、１６．１％和８．８％。观察期间未发生严重并发症,无一例死亡。联合治疗组的４８小时止血率高于其他二组（Ｐ＜０．０５）;一周内再出血率低于内镜注射组（Ｐ＜０．０５）,与热凝治疗组没有明显差别（Ｐ＞０．０５）;手术率低于其他二组（Ｐ＜０．０５）。结论联合应用内镜注射和热探头热凝治疗可以提高消化性溃疡出血的止血率、降低近期再出血率和外科手术率。     

不同Forrest分级溃疡出血患者内镜下注射治疗的疗效观察

目的　探讨不同Forrest分级溃疡出血患者内镜下注射治疗的疗效 ,评估不同Forrest分级溃疡出血患者内镜下注射治疗的必要性。方法　选自 2 0 0 1年 7月至 2 0 0 2年 8月因呕血和 (或 )黑便入院 ,经紧急内镜检查确诊为溃疡性出血患者 81例 ,溃疡出血按Forrest镜下表现分级 ,内镜注射止血治疗组 4 1例 ,内科治疗组 4 0例。结果　内镜组 4 1例 ,止血成功率 95 1% ,对照组 4 0例 ,止血成功率 80 0 % ,两组差异有显著性意义 (P <0 0 5 )。其中ForrestⅠ级、Ⅱa级内镜组止血成功率 (8/ 9、5 / 6 )均高于对照组(3/ 7、3/ 5 ) ,Ⅱb级、Ⅱc级与Ⅲ级两组无明显差异。结论　内镜注射止血治疗简单有效 ,优于单纯药物治疗 ,镜下表现为ForrestI级和Ⅱa级的溃疡出血患者 ,内镜下注射治疗是有效和必要的     

内镜下电凝、钛夹联合注射肾上腺素治疗消化性溃疡出血的临床疗效

目的探讨内镜下电凝、钛夹联合注射肾上腺素治疗消化性溃疡出血的临床疗效。方法选取210例消化性溃疡出血的患者,根据治疗方式分为3组,各70例。内镜注射组为内镜下注射肾上腺素,电凝组治疗方式为电凝联合注射肾上腺素,钛夹组为钛夹联合注射肾上腺素,术后观察比较3组止血效果与术后并发症情况。结果 3组首次止血率、止血失败率比较无统计学差异(P0.05),止血成功率、再出血率比较差异显著(P0.05)。钛夹组止血成功率、再出血率与内镜注射组比较,差异有统计学意义(P0.05)。3组患者均未出现穿孔及其他并发症。结论内镜下电凝、钛夹联合注射肾上腺素治疗消化性溃疡出血疗效相当,且创伤较小,并发症少。     

内镜局部注射治疗消化性溃疡出血的临床观察

探讨一种疗效好,可靠,副作用少,操作简单的内镜下止血方法。以高渗盐水立止血内下注射治疗消化性溃疡出血患者７７例为治疗组,立即止血率９７．９％,再出血率２．５％。     

急症内镜下注射治疗上消化道大出血

目的 观察内镜下注射治疗上消化道大出血的安全性和疗效。方法 对98例经内科常规治疗难以控制的急性上消化道大出血病人行急诊内镜下局部注射1／10000肾上腺素或肾上腺素加无水酒精止血。结果 98例48h止血率为93．8％，1周内再出血率为6．2％，急诊手术率为6．2％。结论 急诊内镜下注射肾上腺素加无水酒精止血，可以尽早明确出血部位，迅速止血，降低上消化道出血病人的再出血率、手术率和病死率，     

内镜下注射肾上腺素喷洒孟氏液治疗消化性溃疡出血的疗效比较

内镜下注射肾上腺素喷洒孟氏液治疗消化性溃疡出血的疗效比较苏鲁洪梅燕潘洪珍上消化道出血是临床上常见的急症之一，由于急诊内镜的检查和治疗，已使即刻止血率达到８０％以上。然而，近期再出血率仍高达２０％左右。因此如何提高止血率，减少再出血率和死亡率，仍是目前...     

内镜下选择性组织粘合剂注射治疗肝硬化食管静脉曲张破裂出血的探讨

目的 探讨内镜下选择性注射组织粘合剂治疗肝硬化食管静脉曲张破裂出血的近期止血和持续止血效果。方法 将40例肝炎后肝硬化食管静脉曲张破出血患者分为组织粘合剂注射治疗组(A组，20例)和对照组(B组，20例)，A组予组织粘合剂(氰丙烯酸盐)1ml及生理盐水2ml以三明治夹心法选择性注入于破裂血管内，B组予垂体后叶素静脉滴注，持续7天。结果 氰丙烯酸盐治疗组中20例均获立即止血(止血率100％)，3天内再出血1例(成功率95％)，2周内持续止血18例(成功率90％)，B组3日内止血13例(65％)，P＜0．05，2周内持续止血10例(50％)，P＜0．01。结论 内镜下选择性注射组织粘合剂治疗肝硬化食管静脉曲张破裂出血，安全，有效。     

内镜下血管钳夹加止血合剂注射治疗消化性溃疡并出血的临床观察

本研究旨在探索治疗溃疡病并出血的新方法。20例溃疡并出血病人采用内镜下钛夹钳夹血管加止血合剂注射治疗(内镜治疗组)。20侧病人中胃溃疡3例。十二指肠球部溃疡17例。重度出血15人,占 75％,中度出血5人,占25％。注射用止血合剂由3％高渗盐水、立止血、肾上腺素组成。另20例溃疡并出血病人采用静脉内药物注射怍为对照(药物治疗组)。药物治疗组20例病人胃溃疡2例,十二指肠球部溃疡18例,重度出血12例,占60％,中度出血8例,占40％,质子泵抑制剂选用奥美拉唑40mg,每日二次静脉注射止血。内镜治疗组人院后12小时内止血19例(占95％),输血量600-1500ml(平均800ml),转外科手术1人(占5％),奥美拉唑治疗组人院后12小时内止血9例(占45％,输血量600-3000ml(平均1500ml),转外科手术5人(占25％)。两组有非常显著性差异。本研究表明,内镜下应用钛血管夹直接钳夹破裂或显露在溃疡面的血管,主要优点是靶向性强.对血破裂所致的喷血、涌血以及血凝块复盖下潜行性出血病灶止血效果确切。在钳夹血管后,自血管夹周围环状多点注射血合剂。可引起组织水肿、血管收缩和凝血而达到止血的目的。血管夹和止血合剂联合应用具有互补和加强疗效的作用,不仅对明显喷血、涌血或显露的血管有效,对溃疡面渗血或钳夹不可靠的病例也有较好的效果。内镜下血管钳夹加上血合剂注射治疗溃疡病并出血,其效果优于应用质子泵抑制剂静脉注射。     

内镜下钛夹联合注射肾上腺素治疗消化性溃疡出血疗效分析北大核心CSCD

目的探讨内镜下钛夹联合注射肾上腺素治疗消化性溃疡出血的临床疗效。方法选取2014年1月至2015年12月期间青海省人民医院消化内科收治的168例消化性溃疡出血患者作为研究对象,根据患者入院顺序进行编号,将其随机分为A、B、C 3组,每组各56例。A组患者接受内镜下金属钛夹夹闭止血治疗,B组患者接受内镜下注射止血治疗,C组患者接受内镜下金属钛夹联合注射止血治疗。治疗完成后,比较3组的临床疗效、即时止血率、再出血率、外科手术率以及术后并发症发生情况。结果治疗前,3组患者的一般资料、病例分布及病情分级等方面比较差异无统计学意义(P>0.05)。治疗后,C组治疗总有效率为94.6%,显著高于A组和B组的82.1%、75.0%(P=0.017);A组与C组的即时止血率均为100%,显著高于B组的92.9%(P=0.017);C组的再次出血发生率为1.8%,显著低于A组和B组的10.7%、16.1%(P=0.034);但在转外科手术率及术后并发症发生率方面,3组比较差异无统计学意义(P>0.05)。结论内镜下金属钛夹联合注射肾上腺素治疗消化性溃疡出血近期疗效确切,具有较好的止血效果,可降低再出血发生率,具有一定的临床价值。     

Combined epinephrine and bipolar probe coagulation vs. bipolar probe coagulation alone for bleeding peptic ulcer: a randomized, controlled trial

BACKGROUND: Endoscopic treatment with combined modalities is considered standard of care for patients with high-risk peptic ulcer bleeding. This study compared epinephrine injection plus bipolar probe coagulation with bipolar probe coagulation alone in patients with high-risk peptic ulcer bleeding. METHODS: Patients with endoscopically confirmed peptic ulcer bleeding (active or visible vessel) seen from January 2000 through December 2002 were prospectively randomized to two groups. The study group (n = 58) had epinephrine injection followed by bipolar coagulation; the control group (n = 56) was treated by bipolar coagulation alone. The primary outcomes assessed were the rate of initial hemostasis and the rate of recurrent bleeding. Secondary outcomes were the following: need for surgical intervention to control bleeding, transfusion requirements, length of hospital stay (in days), and 30-day mortality. RESULTS: The rate of initial hemostasis was significantly higher in the combination therapy group ( p = 0.02; absolute risk reduction 31.6%: 95% CI [5.4, 57.7]). There was no significant difference between the two treatment groups with respect to all other outcomes measures, except that significantly fewer units of blood were transfused in the combination therapy group ( p = 0.006). CONCLUSIONS: In patients with active peptic ulcer bleeding, epinephrine injection plus bipolar coagulation achieved significantly higher rate of initial hemostasis. All other outcome measures were similar with either treatment in patients with non-bleeding stigmata.     

内镜下注射结合静脉注射奥美拉唑对消化性溃疡活动性出血的疗效

目的观察内镜注射治疗联用不同剂量的奥美拉唑(OME)及单用OME对消化性溃疡活动性出血患者的疗效。方法采用随机对照的方法。把101例内镜下有活动性出血的消化性溃疡出血患者，随机分为3组，分别接受①内镜注射止血治疗联用每天2次静脉注射OME40mg，疗程5d；②内镜注射止血治疗联用每天1次静脉注射OME40mg，疗程5d；③单用每天2次静脉注射OME40mg，疗程5d。治疗期间观察患者的止血时间、输血量、再出血情况及住院时间。结果3组患者的再出血率为3/35(8.6％)，9/32(28.1％)，15/34(44.1％)，差异有显著性(P＜0.05)；手术率1/35(2.9％)，2/32(6.3％)，7/34(20.6％)，差异有显著性(P＜0.05)；死亡率0/34(0％)，1/32(3.1％)，1/34(2.9％)，差异无显著性(P＞0.05)；输血量(3.7±2.7)单位(每单位=200m1)，(5±2.5)单位，(2.5±2.4)单位，差异无显著性(P＞0.05)；止血时间分别为(1.8±1.5)d，(3.8±1.9)d，(5.5±2.1)d，差异有显著性(P＜0.05)；住院时间(8.7±2.5)d，(15.7±6.9)d，(17.1±8.3)d，差异有显著性(P＜0.05)。结论内镜注射治疗联用每天2次静脉注射40mgOME疗效最好o     

Endoscopic Doppler ultrasound after injection therapy for peptic ulcer hemorrhage

BACKGROUND/AIMS: A positive Doppler signal in endoscopic Doppler ultrasound at index endoscopy predicts a high risk for rebleeding from peptic ulcer. The aim of this study was to evaluate if a negative Doppler status immediately after injection therapy may exclude a rebleeding from peptic ulcer in a high-risk cohort. METHODOLOGY: Twenty consecutive patients (pts) (age: 68 (33-91) yrs; 11 female) with peptic ulcer bleeding were enrolled. All patients with an actively bleeding ulcer and those with a non-actively bleeding, but Doppler-positive ulcer were treated by injection of adrenaline (1:10,000 dilution). Treatment was performed during index endoscopy until the Doppler status was negative. Patients were followed-up clinically and endoscopically (including Doppler ultrasound) for bleeding recurrence. RESULTS: Patients were treated by injection of 12 (6 to 20) mL of adrenaline solution until Doppler scan was negative. During follow-up four pts (20%) had a clinically overt rebleeding episode. At control endoscopy three ulcers were actively bleeding and another two were Doppler positive without rebleeding (total: five of eighteen (27.7%) Doppler-positive ulcers). Two of the twenty pts required surgical therapy due to rebleeding (10%). CONCLUSIONS: A negative endoscopic Doppler status immediately after injection therapy is not helpful to identify patients with no risk for rebleeding from peptic ulcer.     

Endoscopic Injection of Absolute Ethanol Achieves Ultimate Hemostasis in Bleeding Caused by Peptic Ulcers

Abstract: This study was performed to assess the efficacy of endoscopic injection therapy with absolute ethanol to prevent emergency surgery and recurrent bleeding in patients with peptic ulcers. We compared two different treatment protocols of peptic ulcers with active bleeding or with visible vessels on the ulcer bed. In group I (1981–1984, control group), 45 patients underwent emergency endoscopy with spraying 0.1% epinephrine and thrombin, but no other endoscopic hemostatic procedure. In group II (1989–1992, experimental group), we performed endoscopic injection therapy with absolute ethanol for peptic ulcers in 46 patients. The background characteristics of the patients were not different in the two groups. The rate of successful initial hemostasis tended to be greater in the ethanol injection group compared with the control group without significance. The ultimate hemostatic rate in the ethanol injection group was markedly and significantly greater compared to the control group (P<0.05). Ultimate hemostasis by ethanol injection was performed effectively in peptic ulcers with spurting and oozing hemorrhage and in the non-bleeding peptic ulcers with visible vessels at the initial endoscopy (P<0.05 for each). These results indicate that ethanol injection therapy by endoscopy achieves ultimate hemostasis and prevents emergency surgery due to hemorrhage from peptic ulcers. (Dig Endoc 1994; 6 : 34–38)     

Peptic ulcer bleeding: comparison of two hemostatic procedures

OBJECTIVE: Bleeding is a serious complication of peptic ulcer. Endoscopic injection therapy is accepted as a homeostatic endoscopic treatment in acute nonvariceal of upper GI hemorrhages, particularly in bleeding peptic ulcers. The risk of rebleeding is predicted by the endoscopic appearance of ulcer features classified according to Forrest's criteria. METHODS: Two hundred twenty-three patients were selected from 1,003 emergency upper endoscopies for GI bleeding. According to Forrest's criteria, 99 well-matched patients with ulcers F1 and F2 were considered at risk of rebleeding; 54 patients (group A) received local ulcer injection of epinephrine solution 1:10,000, whereas (group B) patients were treated with local epinephrine injection and then with endoscopic Hemoclips. (1) We considered the control of bleeding, the number of rebleeding episodes, the need for emergency surgery, and mortality. RESULTS: Bleeding ulcers stopped completely in 83.3% group A patients, and in 95.6% group B patients (p = not significant). In a subset of F1b patients the rebleeding rate was 31 % for group A and 0% for group B (p < 0.05). There was no mortality as a result of the procedure. There was a trend toward reducing surgery in favor of the combined therapy (0% vs 7.4%). No differences were found in transfusion requirements or mean hospitalization days. CONCLUSIONS: We conclude that endoscopic injection of l:10,000 epinephrine solution alone and epinephrine solution plus application of Hemoclips are equivalent therapies in treating bleeding and rebleeding from peptic ulcers. There was no difference between therapies in terms of need for surgery or mortality. Possibly combination therapy is more effective in treating ulcers that are actively oozing.     

Efficacy of endoscopic clipping for actively bleeding peptic ulcer: comparison with polidocanol injection therapy

BACKGROUND/AIMS: The use of hemostatic clips is conceptually attractive for achieving definitive hemostasis in peptic ulcer bleeding. There are only a few clinical trials comparing clipping with other endoscopic hemostatic methods. The aim of this study is to assess the efficacy and safety of endoscopic clipping with that of injection of polidocanol for hemostasis from actively (spurting or oozing) bleeding peptic ulcer. METHODOLOGY: 61 patients with active (spurting or oozing) bleeding gastroduodenal ulcers were randomly assigned to one of two endoscopic treatments: injection therapy with polidocanol 1% (injected in 0.5-1.0 mL increments at three to five sites around the bleeding vessel to a total of 5 mL) (n=30), or endoscopic clipping using a clipping device and clips (n=31). All patients from the polidocanol group and 22 (68.8%) patients from the clipping group received pretreatment with epinephrine. Hemostatic rates, rebleeding rates, amounts of blood transfusion, and durations of hospital stay were analyzed. RESULTS: The initial hemostatic rate was 96.8% in the clipping group, and 96.7% in the polidocanol group, respectively. Mean transfusion requirements, mean number of hospital days and percentage needing surgery were comparable in both groups. Recurrent bleeding rates were higher, although not statistically significant in the polidocanol group than in the clipping group (13.3% vs. 6.5%, respectively). CONCLUSIONS: Our data suggest that injection therapy with polidocanol and endoscopic hemoclips seems to be equivalent for actively (spurting and oozing) bleeding peptic ulcer.     

钛金属夹与肾上腺素盐水注射法治疗消化性溃疡出血的对照研究

目的对照研究内镜下注射肾上腺素盐水与钛金属夹钳夹法治疗消化性溃疡出血的疗效。方法将68例消化性溃疡出血的病人(男40例,女28例,平均年龄42.62±3.57岁)分成金属夹组(n=35)和注射组(n=33),进行内镜止血治疗。结果两组病例均即时止血,两组的再出血率分别为5.71％(2/35)和9.09％(3/33)(P>0.05),两组治疗相关性并发症发生率分别为0％和42％(14/33)(P<0.01)。结论应用钛金属夹治疗上消化性溃疡出血具有设备简单、疗效好、安全性高、几无并发症等优点,值得推广应用。     

Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial

Aim: Recurrent bleeding after initial haemostasis is an important factor that directly relates to the outcome in the management of peptic ulcer bleeding. Conflicting reports have been published concerning the effectiveness of scheduled second therapeutic endoscopy on ulcer rebleeding. We investigate the use of scheduled second endoscopy with appropriate therapy on peptic ulcer rebleeding. METHODS: From August 1999 to January 2001, we prospectively randomised patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of acute bleeding, visible vessel, or adherent clot into two groups. Endoscopic therapy was standardised to initial epinephrine injection and subsequent heater probe application. The study group (n = 100) received scheduled second endoscopy 16-24 hours after initial haemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. The control group (n = 94) were observed closely. Those patients that developed rebleeding in either group underwent operation if further endoscopic therapy failed. Outcome measures included ulcer rebleeding, transfusion, duration of stay, and mortality. RESULTS: After initial endoscopic haemostasis, 194 eligible patients were randomised into two groups. Thirteen patients in the control group developed recurrent bleeding within 30 days while five patients in the study group sustained recurrent bleeding (p = 0.0314) (relative risks 0.33, 95% confidence interval 0.1-0.96). The number of patients that required surgery for recurrent bleeding was six in the control group and one in the study group (p = 0.05). There was no difference in duration of hospital stay, transfusion, or mortality between the two groups. CONCLUSIONS: A scheduled repeat endoscopy with appropriate therapy 16-24 hours after initial endoscopic haemostasis reduces the number of cases of recurrent bleeding.     

Role of intravenous omeprazole in patients with high-risk peptic ulcer bleeding after successful endoscopic epinephrine injection: a prospective randomized comparative trial

BACKGROUND: Epinephrine injection is the most common endoscopic therapy for peptic ulcer bleeding. Controversy exists concerning the optimal dose of proton pump inhibitors (PPI) for patients with bleeding peptic ulcers after successful endoscopic therapy. The objective of this study was to determine the optimal dose of PPI after successful endoscopic epinephrine injection in patients with bleeding peptic ulcers. METHODS: A total of 200 peptic ulcer patients with active bleeding or nonbleeding visible vessels (NBVV) who had obtained initial hemostasis with endoscopic injection of epinephrine were randomized to receive omeprazole 40 mg infusion every 6 h, omeprazole 40 mg infusion every 12 h or cimetidine (CIM) 400 mg infusion every 12 h. Outcomes were checked at 14 days after enrollment. RESULTS: Rebleeding episodes were fewer in the group with omeprazole 40 mg infusion every 6 h (6/67, 9%) as compared with that of the CIM infusion group (22/67, 32.8%, p < 0.01). The volume of blood transfusion was less in the group with omeprazole 40 mg every 6 h than in those groups with omepraole 40 mg infusion every 12 h (p= 0.001) and CIM 400 mg infusion every 12 h (p < 0.001). The hospital stay, number of patients requiring urgent operation, and death rate were not statistically different among the three groups. CONCLUSION: A combination of endoscopic epinephrine injection and a large dose of omeprazole infusion is superior to combined endoscopic epinephrine injection with CIM infusion for preventing recurrent bleeding from peptic ulcers with active bleeding or NBVV.