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The clinical outcome of upper gastrointestinal bleeding has improved due to advances in endoscopic therapy and standardized peri‐endoscopy care. Apart from validating clinical scores, artificial intelligence‐assisted machine learning models may play an important role in risk stratification. While standard endoscopic treatments remain irreplaceable, novel endoscopic modalities have changed the landscape of management. Over‐the‐scope clips have high success rates as rescue or even first‐line treatments in difficult‐to‐treat cases. Hemostatic powder is safe and easy to use, which can be useful as temporary control with its high immediate hemostatic ability. After endoscopic hemostasis, Doppler endoscopic probe can offer an objective measure to guide the treatment endpoint. In refractory bleeding, angiographic embolization should be considered before salvage surgery. In variceal hemorrhage, banding ligation and glue injection are first‐line treatment options. Endoscopic ultrasound‐guided therapy is gaining popularity due to its capability of precise localization for treatment targets. A self‐expandable metal stent may be considered as an alternative option to balloon tamponade in refractory bleeding. Transjugular intrahepatic portosystemic shunting should be reserved as salvage therapy. In this article, we aim to provide an evidence‐based comprehensive review of the major advancements in endoscopic hemostatic techniques and clinical outcomes. 相似文献
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Pyeong Hwa Kim Jiaywei Tsauo Ji Hoon Shin Sung-Cheol Yun 《Journal of vascular and interventional radiology : JVIR》2017,28(4):522-531.e5
Purpose
To evaluate the safety and efficacy of transcatheter arterial embolization with N-butyl cyanoacrylate (NBCA) for the treatment of gastrointestinal (GI) bleeding via a meta-analysis of published studies.Materials and Methods
The MEDLINE/PubMed and EMBASE databases were searched for English-language studies from January 1990 to March 2016 that included patients with nonvariceal GI bleeding treated with transcatheter arterial embolization with NBCA with or without other embolic agents. The exclusion criteria were a sample size of < 5, no extractable data, or data included in subsequent articles or duplicate reports.Results
The cases of 440 patients (mean age, 63.8 y ± 14.3; 319 men [72.5%] and 121 women [27.5%]) from 15 studies were evaluated. Of these patients, 261 (59.3%) had upper GI bleeding (UGIB) and 179 (40.7%) had lower GI bleeding (LGIB). Technical success was achieved in 99.2% of patients with UGIB (259 of 261) and 97.8% of those with LGIB (175 of 179). The pooled clinical success and major complication rates in the 259 patients with UGIB in whom technical success was achieved were 82.1% (95% confidence interval [CI], 73.0%–88.6%; P = 0.058; I2 = 42.7%) and 5.4% (95% CI, 2.8%–10.0%; P = 0.427; I2 = 0.0%), respectively, and those in the 175 patients with LGIB in whom technical success was achieved were 86.1% (95% CI, 79.9%–90.6%; P = 0.454; I2 = 0.0%) and 6.1% (95% CI, 3.1%–11.6%; P = 0.382; I2 = 4.4%), respectively.Conclusions
Transcatheter arterial embolization with NBCA is safe and effective for the treatment of GI bleeding. 相似文献5.
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为明确急诊内镜在上消化道大出血诊断和治疗中的价值.选择26例病人进行前瞻性观察,结果表明:急诊内镜组诊断率为96%,3天止血率为73.8%.平均止血时间3.7±2.7天;与对照组比较有显著性或非常显著性差异,证实了急诊内镜在上消化道大出血的诊断治疗中具有不可替代的优先位置. 相似文献
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《Mayo Clinic proceedings. Mayo Clinic》2017,92(5):797-804
The evaluation of the patient with hematochezia can be complex because of the broad differential diagnosis and the number of management strategies available. In this article, a simplified approach to the history and physical examination is presented, with management illustrated in a case-oriented manner. 相似文献
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