Endoscopic hemoclip treatment for bleeding peptic ulcer

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.

Successful endoscopic hemoclipping of massive lower gastrointestinal bleeding from paratyphoid A fever

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.

Endoscopic treatment of non-variceal gastrointestinal bleeding:hemoclips and other hemostatic techniques

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

Epinephrine injection therapy versus a combination of epinepnrine injection and endoscopic hemoclip in the treatment of bleeding ulcers

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.

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 hematemesis 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 wasan effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.

尼龙绳套扎和金属止血夹联合应用治疗消化性溃疡出血的应用价值

目的探讨尼龙绳套扎和金属止血夹联合应用在治疗消化性溃疡并出血中的临床应用价值。方法回顾性分析2012年1月-2014年6月该院内镜中心应用尼龙绳套扎和金属止血夹联合治疗消化性溃疡并出血患者的临床资料,评价其安全性和疗效。结果 53例患者消化性溃疡并出血病例经胃镜下尼龙绳套扎和金属止血夹联合应用治疗后即时止血率100%。3例患者术后再次出血,经再次内镜治疗后成功止血。所有病例术后恢复良好。结论胃镜下尼龙绳套扎和金属止血夹联合应用治疗消化性溃疡并出血的安全性和疗效值得肯定。

内镜止血夹治疗急性上消化道大出血的临床研究

目的 :检验内镜止血夹对急性上消化道大出血的止血疗效 ,并初步探讨其影响疗效的相关因素。方法 :采用OlympusSHX - 5LR - 1止血夹置放器和MD85 0内镜止血夹。止血夹以直角夹闭出血病灶。结果 :18例急性上消化道大出血均获得即时止血 ,无 1例发生再出血和并发症。结论 :内镜止血夹为急性上消化道大出血提供了一种损伤小、止血成功率和安全性高的治疗方法。

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。

橡皮圈牵引与牙线牵引辅助内镜黏膜下剥离术治疗消化道肿瘤的临床对比研究

目的·比较橡皮圈牵引与牙线牵引辅助内镜黏膜下剥离术(ESD)治疗消化道肿瘤的效果。方法·以橡皮圈牵引辅助ESD治疗消化道肿瘤的27例患者为试验组,牙线牵引辅助ESD治疗的患者27例为牙线组,观察相关指标,比较2组手术时间、牵引装置安装时间、止血夹脱离次数、黏膜损伤情况、一次性完整切除率、并发症及随访情况。结果·橡皮圈组止血夹脱离次数(2次)明显短于牙线组止血夹脱离次数(8次),差异具有统计学意义(t=4.418,P<0.05);橡皮圈组未发生装置引起的口咽部黏膜损伤,牙线组口咽部黏膜损伤3例(11.1%);2组一次性完整切除率均为100%;2组手术时间、牵引装置安装时间、并发症发生率比较,差异无统计学意义(P>0.05);2~12个月的随访后,橡皮圈组患者创面愈合良好,均无肿瘤局部复发。结论·橡皮圈牵引辅助ESD与牙线牵引辅助ESD相比,装置不易脱离,尤其适合右半结肠的牵引辅助治疗,不易损伤组织黏膜,牵引方向可调节,是一种方便和有效的辅助装置。

经结肠镜高频电圈套器或IT刀联合止血夹治疗大肠宽蒂大息肉56例分析

目的评价结肠镜下使用止血夹协助高频电圈套器或IT刀切除大肠宽蒂息肉的疗效及安全性。方法在用圈套器或IT刀切除宽蒂大息肉前后使用止血夹钳夹蒂柄治疗大肠宽蒂息肉56例,随访观察术后出血、穿孔情况。结果本组56例大肠宽蒂息肉均一次性切除成功,术后未出现出血、穿孔并发症。结论止血夹能有效防止切除宽蒂大息肉后并发的出血和穿孔。结肠镜下使用止血夹协助高频电圈套器或IT刀切除大肠宽蒂大息肉安全、有效。

经内镜金属夹钳夹术治疗上消化道出血

目的 :探讨内镜金属钛夹治疗上消化道出血的应用价值。方法 :使用OlympusGIF130电子胃镜及Olym pus钛夹 (MD85 0型 )及推送器 (HX - 5LR -I)。结果 :既时止血率达 10 0 % ,无 1例出现再出血和并发症 ;9例患者共用金属夹 2 1枚 ,平均每例 2 .1枚。结论 :经内镜金属夹治疗上消化道出血疗效高 ,创伤小 ,适应症广 ,并发症少 。

内镜治疗非静脉曲张上消化道出血随机对照试验的Meta分析

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。

消化道大出血金属钛夹治疗与外科手术治疗的效价比较

目的通过观察金属钛夹及外科手术对消化道大出血的治疗效果及治疗费用,探讨内镜下金属钛夹治疗急性消化道大出血的临床应用价值及经济学价值。方法钛夹止血组(A组)采用经内镜对出血病灶放置金属钛夹止血;外科手术组(B组)采用“病灶切除术或胃大部切除术”。结果金属钛夹治疗组止血率100.0%,并发症发生率为0,平均住院时间17·82天,平均总住院费用5698.76元;外科手术治疗组止血率100.0%,术后并发症发生率42·86%,平均住院时间23.65天,平均总住院费用15831.56元。结论金属钛夹治疗消化道大出血具有止血效果确切、操作安全、简便、无并发症,费用低等优点,具有良好的效价比。

心血管介入和手术后食管贲门黏膜撕裂的临床及内镜特点

目的探讨心血管介入和手术后食管贲门黏膜撕裂的临床特点。方法回顾性分析2015年3月~2019年3月经电子胃镜检查诊断为食管贲门黏膜撕裂综合征并出血,且发病前1周内有心脏及大血管介入或手术史24例的临床、内镜资料。发病前均有呕吐的症状,继而出现呕血或胃管内抽出暗红色血。结果内镜下均为纵行撕裂,好发生于贲门部(14例,58. 3%),多见于左侧壁(10例,41. 7%)、后壁(8例,33. 3%),单处撕裂多见(19例,79. 2%)。75. 0%(18/24)有活动性出血(Chung分级Ⅰ级3例,Ⅱ级15例)。2例Chung分级Ⅳ级者无需止血治疗;余22例采用以金属钛夹为基础的联合止血方式,止血成功20例,2例内镜下止血失败者行腹主动脉和腹腔干造影联合胃左动脉栓塞止血。结论心血管介入治疗和手术后出现呕血或胃管内抽出暗红色血的患者应考虑到食管贲门黏膜撕裂并出血的可能,胃镜下止血是有效的治疗方法。

合理应用止血夹结合肾上腺素盐水注射治疗胃肠道出血

目的 探讨内镜下合理应用止血夹结合肾上腺素盐水注射治疗胃肠道出血的疗效。方法 根据出血情况选用单用止血夹或止血夹结合注射治疗。共 4 5例胃肠道出血病人接受治疗。其中 35例单用止血夹 ,10例先注射肾上腺素盐水再用止血夹。结果 单用止血夹即时止血率 94 .2 8% (33/35 ) ,加用注射治疗后总的即时止血率达 10 0 % (45 /45 )。再出血率 2 .2 % (1/45 )。结论 合理应用止血夹结合肾上腺素盐水注射是治疗胃肠道出血的一种安全、有效的方法。

内镜下金属夹和医用胶封堵消化道瘘口9例报道

目的探讨内镜下金属夹夹闭和医用胶封堵消化道瘘口的治疗效果。方法对手术后出现腹腔引流管引流液增加并见胃肠液和食物的5例患者行胃镜检查,对阴道流出粪便或直肠流出尿液的4例患者行肠镜检查,发现瘘口,内镜下行医用胶封堵或金属夹夹闭联合应用医用胶封堵瘘口。结果4例镜下医用胶封堵瘘口成功,5例金属夹联合医用胶封堵瘘口成功。结论消化道瘘口内镜下医用胶封堵或联合金属夹夹闭,成功率高、操作简单、费用低廉、痛苦小、避免了再次手术,临床应用广泛。

内镜下止血夹治疗消化道肿瘤术后吻合口出血

目的探讨内镜下止血夹治疗消化道肿瘤术后吻合口出血的价值。方法14例术后发现吻合口出血的消化道肿瘤病例，包括食管癌5例、胃癌3例、胃问质瘤2例及直肠癌4例，接受内镜下止血夹治疗并观察其止血效果。结果14例患者中，除1例胃癌患者因出血量大难以观察出血部位外，其余13例患者均内镜下止血成功。结论消化道肿瘤术后吻合口可能因吻合时黏膜撕裂或黏膜下血管未能完全封闭导致术后出血，采用内镜下止血夹夹闭出血点对治疗吻合口出血、避免再次开放性手术具有良好的应用价值。

内镜下注射与钛夹联合治疗食管贲门黏膜撕裂综合征出血的临床研究

目的探讨内镜下金属钛夹与注射联合应用在食管贲门黏膜撕裂综合征出血患者中的治疗价值。方法对我科2005年1月~2010年1月所诊治的83例食管贲门黏膜撕裂综合征（MWS）出血患者进行随机分组,A组行内镜下注射＋金属钛夹治疗,B组单纯行内镜下金属钛夹治疗。分析两组治疗时间、止血效果和再出血等方面的差异。结果 A组患者平均治疗时间12.6 min;B组患者平均治疗时间15.2 min。83例患者经两种方法治疗后,均可立即止血。A组无再次出血患者,B组2例患者再出血。结论内镜下注射＋金属钛夹联合治疗食管贲门黏膜撕裂出血具有止血效果确实可靠、定位准确和操作简便等优点,可作为食管贲门黏膜裂出血的首选治疗。

内镜下止血夹治疗消化性溃疡出血疗效观察

目的探讨内窥镜下止血夹治疗Forrest分级为Ⅰ级、Ⅱ级、Ⅲ级消化性溃疡出血的止血疗效。方法两组患者的内科治疗程度一样的情况下,止血夹组的患者进行内镜下止血夹的对应治疗,注射组患者进行内镜下局部注射的对应治疗。结果两组及时止血率同样为100%,止血夹组48h之内的出血复发率为2%(有1名患者发生再次出血情况),注射组48h之内的出血复发率为16%(有8名患者发生再次出血情况)。故两组的初次止血成功率有明显差异,该差异具有统计学意义(P<0.05)。结论内镜下止血夹对治疗溃疡性出血有明显效果。并具有止血快速,简单易行,安全的特点。

内镜金属夹联合电凝切除老年人结肠巨大息肉62例疗效分析

采用OlympusCF-Q240型电子结肠镜、OlympusPSD-30高频电发生器、OlympusHX-5LR-1金属夹释放器、MD-850型金属夹、圈套器等,对62例老年人结肠巨大息肉钳夹后电凝切除,术后定期随访,观察疗效。62例老年患者共切除息肉86枚,平均放置金属夹2.6枚,未发生严重并发症。内镜下金属夹联合高频电凝切除老年人结肠巨大息肉是一种安全高效的微创治疗方法,完全可以替代手术治疗。