AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combin...AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection alone.METHODS: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures studied.RESULTS: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly different.CONCLUSION: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.展开更多
AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospecti...AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospective studyfor endoscopic hemoclip treatment.We used anewly developed rotatable clip-device for theapplication of hemoclip(MD850)to stopbleeding.Endoscopy was repeated if there wasany sign or suspicion of rebleeding,and re-clipping was performed if necessary andfeasible.RESULTS Initial hemostatic rate by clippingwas 95%,and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%,96%,and93% in the Fla and Flb subgroups,and totalcases,respectively.In patients with shock onadmission,hemoclipping achieved ultimatehemostasis of 71% and 83% in F1a and F1bsubgroups,respectively.Hemostasis reached100% in patients without shock regardless ofhemorrhagic activity being F1a or F1b.Theaverage number of clips used per case was 3.0(range 2-5).Spurting bleeders required moreclips on average than did oozing bleeders(3.4versus 2.8).We observed no obviouscomplications,no tissue injury,or impairmentof ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placementis an effective and safe method.With theimprovement of the clip and application device,the procedure has become easier and much moreefficient.Endoscopic hemoclipping deservesfurther study in the treatment of bleeding pepticulcers.展开更多
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...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.展开更多
Paratyphoid fever can be complicated by massive lower gastrointestinal bleeding with ileocolonic ulcerations,which are commonly localized using colonoscopy.The most common manifestations include multiple,variablesized...Paratyphoid fever can be complicated by massive lower gastrointestinal bleeding with ileocolonic ulcerations,which are commonly localized using colonoscopy.The most common manifestations include multiple,variablesized,round or oval-shaped,punched-out ulcers.Occasionally,massive lower gastrointestinal bleeding can occur from erosion of blood vessels.We present arare case of severe lower gastrointestinal bleeding due to paratyphoid A fever that was successfully controlled with hemoclippings.A 30-year-old man experienced high fever and hematochezia whose blood culture showed Salmonella paratyphi A.A complete colonoscopy was successfully performed up to the level of the terminal ileum,which showed multiple,shallow,ulcerated lesions over the entire terminal ileum.A bleeding vessel was seen in one of the ulcers,with overlaying blood clots.Endoscopic hemostasis was successfully performed with four pieces of endoclip and without immediate complication.This report highlights the use of colonoscopy and endoscopic therapy with endoclips for lower gastrointestinal bleeding,which should be considered before surgery.展开更多
Although the number of hospitalizations for non-variceal gastrointestinal bleeding has decreased inrecent years,acute upper gastrointestinalhemorrhage continues to be a common reason forhospital admission,and peptic u...Although the number of hospitalizations for non-variceal gastrointestinal bleeding has decreased inrecent years,acute upper gastrointestinalhemorrhage continues to be a common reason forhospital admission,and peptic ulcers account for atleast fifty percent of all cases.Despite the fact thatbleeding from ulcers ceases spontaneously inapproximately 80% of patients,it is still a展开更多
目的比较不同内镜方式治疗非静脉曲张上消化道出血(NVUGB)的效果。方法在Pubmed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数据库检索自建库以来至2018年11月公开发表的...目的比较不同内镜方式治疗非静脉曲张上消化道出血(NVUGB)的效果。方法在Pubmed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数据库检索自建库以来至2018年11月公开发表的、有关内镜治疗NVUGB的所有中英文随机对照试验(RCT),对纳入的研究进行质量评价,采用Revman 5.3软件进行Meta分析。结果经过文献筛选后,共37篇RCT最终被纳入分析,共3064例患者。Meta分析结果显示,金属钛夹与药物局部注射比较,即时止血成功率高(RR=1.12,95%CI:1.04~1.21)、再出血率低(RR=0.30,95%CI:0.22~0.42)、急诊外科手术率低(RR=0.24,95%CI:0.13~0.42);金属钛夹与热凝止血比较,再出血率低(RR=0.32,95%CI:0.16~0.65)、即时止血成功率差异无统计学意义(RR=0.96,95%CI:0.89~1.05)、急诊外科手术率差异无统计学意义(RR=0.43,95%CI:0.15~1.25);热凝止血与局部药物注射比较,即时止血成功率差异无统计学意义(RR=1.02,95%CI:0.98~1.05)、再出血率差异无统计学意义(RR=0.98,95%CI:0.76~1.27)、急诊外科手术率差异无统计学意义(RR=1.03,95%CI:0.75~1.41)。结论内镜下金属钛夹治疗NVUGB的疗效优于药物局部注射和热凝止血,具有临床推广和应用价值。展开更多
文摘AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection alone.METHODS: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures studied.RESULTS: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly different.CONCLUSION: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.
文摘AIM To evaluate the efficacy of endoscopichemoclip in the treatment of bleeding pepticulcer.METHODS Totally,40 patients with F1a andFib hemorrhagic activity of peptic ulcers wereenrolled in this uncontrolled prospective studyfor endoscopic hemoclip treatment.We used anewly developed rotatable clip-device for theapplication of hemoclip(MD850)to stopbleeding.Endoscopy was repeated if there wasany sign or suspicion of rebleeding,and re-clipping was performed if necessary andfeasible.RESULTS Initial hemostatic rate by clippingwas 95%,and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%,96%,and93% in the Fla and Flb subgroups,and totalcases,respectively.In patients with shock onadmission,hemoclipping achieved ultimatehemostasis of 71% and 83% in F1a and F1bsubgroups,respectively.Hemostasis reached100% in patients without shock regardless ofhemorrhagic activity being F1a or F1b.Theaverage number of clips used per case was 3.0(range 2-5).Spurting bleeders required moreclips on average than did oozing bleeders(3.4versus 2.8).We observed no obviouscomplications,no tissue injury,or impairmentof ulcer healing related to hemoclipping.CONCLUSION Endoscopic hemoclip placementis an effective and safe method.With theimprovement of the clip and application device,the procedure has become easier and much moreefficient.Endoscopic hemoclipping deservesfurther study in the treatment of bleeding pepticulcers.
文摘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.
文摘Paratyphoid fever can be complicated by massive lower gastrointestinal bleeding with ileocolonic ulcerations,which are commonly localized using colonoscopy.The most common manifestations include multiple,variablesized,round or oval-shaped,punched-out ulcers.Occasionally,massive lower gastrointestinal bleeding can occur from erosion of blood vessels.We present arare case of severe lower gastrointestinal bleeding due to paratyphoid A fever that was successfully controlled with hemoclippings.A 30-year-old man experienced high fever and hematochezia whose blood culture showed Salmonella paratyphi A.A complete colonoscopy was successfully performed up to the level of the terminal ileum,which showed multiple,shallow,ulcerated lesions over the entire terminal ileum.A bleeding vessel was seen in one of the ulcers,with overlaying blood clots.Endoscopic hemostasis was successfully performed with four pieces of endoclip and without immediate complication.This report highlights the use of colonoscopy and endoscopic therapy with endoclips for lower gastrointestinal bleeding,which should be considered before surgery.
文摘Although the number of hospitalizations for non-variceal gastrointestinal bleeding has decreased inrecent years,acute upper gastrointestinalhemorrhage continues to be a common reason forhospital admission,and peptic ulcers account for atleast fifty percent of all cases.Despite the fact thatbleeding from ulcers ceases spontaneously inapproximately 80% of patients,it is still a
文摘目的比较不同内镜方式治疗非静脉曲张上消化道出血(NVUGB)的效果。方法在Pubmed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数据库检索自建库以来至2018年11月公开发表的、有关内镜治疗NVUGB的所有中英文随机对照试验(RCT),对纳入的研究进行质量评价,采用Revman 5.3软件进行Meta分析。结果经过文献筛选后,共37篇RCT最终被纳入分析,共3064例患者。Meta分析结果显示,金属钛夹与药物局部注射比较,即时止血成功率高(RR=1.12,95%CI:1.04~1.21)、再出血率低(RR=0.30,95%CI:0.22~0.42)、急诊外科手术率低(RR=0.24,95%CI:0.13~0.42);金属钛夹与热凝止血比较,再出血率低(RR=0.32,95%CI:0.16~0.65)、即时止血成功率差异无统计学意义(RR=0.96,95%CI:0.89~1.05)、急诊外科手术率差异无统计学意义(RR=0.43,95%CI:0.15~1.25);热凝止血与局部药物注射比较,即时止血成功率差异无统计学意义(RR=1.02,95%CI:0.98~1.05)、再出血率差异无统计学意义(RR=0.98,95%CI:0.76~1.27)、急诊外科手术率差异无统计学意义(RR=1.03,95%CI:0.75~1.41)。结论内镜下金属钛夹治疗NVUGB的疗效优于药物局部注射和热凝止血,具有临床推广和应用价值。
