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Endoscopic Hemostasis of Nonvariceal Gastrointestinal Bleeding  [PDF]
Yoshihiro Inoue, Yasuhisa Fujino, Makoto Onodera, Satoshi Kikuchi, Masayuki Sato, Hisaho Sato, Masahiro Kojika, Shigeatsu Endo
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.519147
Abstract: We investigated 2668 patients with non-variceal upper gastrointestinal bleeding and 660 patients with lower gastrointestinal bleeding treated between 1987 and 2011 in our hospital. Upper gastrointestinal bleeding was associated with gastric ulcer, duodenal ulcer, Mallory-Weiss syndrome, esophageal disease, and others. Endoscopic hemostasis was performed in approximately 67% of all cases with upper gastrointestinal bleeding and approximately 90% of cases with ulcer. The hemostasis success rate was over 90% for ulcer bleeding, and was also generally high for other diseases. The total number of patients with lower gastrointestinal bleeding was lower, with it being approximately 20% of those with upper gastrointestinal bleeding. Endoscopic hemostasis was performed in approximately 30% of the patients with lower gastrointestinal bleeding. The hemostasis success rate was generally high, but treatment switch to surgery or interventional radiology (IVR) was observed in some cases with colorectal diverticular bleeding.
Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract  [cached]
Shi-Bin Guo, Ai-Xia Gong, Jing Leng, Jing Ma, Lin-Mei Ge
World Journal of Gastroenterology , 2009,
Abstract: 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 was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.
Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding
Young-Seok Cho, Hiun-Suk Chae, Hyung-Keun Kim, Jin-Soo Kim, Byung-Wook Kim, Sung-Soo Kim, Sok-Won Han, Kyu-Yong Choi
World Journal of Gastroenterology , 2008,
Abstract: AIM: To compare the hemostatic efficacy and safety of two mechanical endoscopic methods: endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP) in patients with actively bleeding Mallory-Weiss syndrome (MWS).METHODS: A prospective randomized study to compare the efficacy and safety of EHP with EBL was performed from January 2002 to August 2005. Forty-one patients with active bleeding from MWS were treated with EHP (n = 21) or EBL (n = 20).RESULTS: There were no significant differences between groups with respect to clinical and endoscopic characteristics. The mean number of hemoclips applied was 3.2 ± 1.5 and the mean number of bands applied was 1.2 ± 0.4. Primary hemostasis was achieved in all patients. Recurrent bleeding was observed in one patient from the EHP group and two from the EBL group. Patients with recurrent bleeding were treated by the same modality as at randomization and secondary hemostasis was achieved in all. There were no significant differences between the two groups in total transfusion amount or duration of hospital stay. No complications or bleeding-related death resulted.CONCLUSION: EHP and EBL are equally effective and safe for the management of active bleeding in patients with Mallory-Weiss syndrome, even in those with shock or comorbid diseases.
Prospective Assessment of the Rockall Risk Scoring System in Egyptian Patients with Upper Gastrointestinal Bleeding  [PDF]
Mohga A. Reda, Iman F. Montasser, Shereen A. Saleh, Azza M. Hassan, Alaa Eldein I. Ewis
Open Journal of Gastroenterology (OJGas) , 2015, DOI: 10.4236/ojgas.2015.56012
Abstract: Background: One of the major challenges in managing acute upper gastrointestinal bleeding involves the identification of patients who are at high risk of rebleeding and death; conversely, the identification of patients who are suitable for early discharge and outpatient endoscopy is also important for effective resource. The use of Rockall system has been shown to represent accurate and valid predictor of rebleeding and death. The aim of this prospective study was to evaluate validity of Rockall score for prediction of rebleeding and mortality in Egyptian patients with upper gastrointestinal bleeding. Patients and Methods: 50 patients presented with upper GI bleeding were subjected to detailed clinical, laboratory, sonographic and endoscopic examination together with Rockall score calculation. Results: According to the findings of upper GI endoscopy patients were further subdivided into two subgroups as follows: Group 1 (n = 32): Patients with portal hypertension manifested by variceal bleeding and/or portal hypertensive gastropathy; and Group 2 (n = 18): other causes of acute upper gastrointestinal bleeding (peptic ulcer disease, Mallory Weiss syndrome…). Clinical condition of the patients was assessed after 48 hours and mortality was recorded. Rockall score was the highest in mortality group, and higher in rebleeding group than stable group (P < 0.01). Rockall score was higher in Child C than Child B and Child A among hepatic patients (P < 0.01). The cutoff value of Rockall score = 3.5 was the best for prediction of rebleeding with sensitivity 100%, specificity 53%, while the cutoff value = 6.5 was the best for prediction of mortality with sensitivity 100% and 93.5% specificity. Conclusion: Rockall score is clinically useful in prediction of rebleeding and mortality in patients with upper gastrointestinal bleeding. It can accurately differentiate between patients with stable condition that could be discharged from hospital and those who require hospitalization and this could help to minimize hospital stay and cost.
Less frequent causes of upper gastrointestinal bleeding  [PDF]
Sabljak P.,Veli?kovi? D.,Stojakov D.,Bjelovi? M.
Acta Chirurgica Iugoslavica , 2007, DOI: 10.2298/aci0701119s
Abstract: Upper gastrointestinal (GI) bleeding represents emergency which despites modern advances in treatment still carry substantial mortality. Mortality remained relatively constant in the last 50 years at approximately 12%. Peptic ulcers remain the most common cause of upper GI bleeding and account approximately 50% of all cases. Next leading causes are esophageal and gastric varices, and gastroduodenal erosions. Mallory Weiss tears, angiodysplasia and gastric antral vascular ectasia (GAVE)-Watermelon stomach are less frequent but important causes of upper GI bleeding that contribute substantially to the overall morbidity and mortality. Recognition of such lesions is crucial to provide effective hemostasis. In most cases endoscopic therapy is procedure of choice which significantly improved the outcome of patients. In cases where endoscopic hemostasis is not effective, or patients rebleed after initial control surgical therapy may be required. This article will review recent advances in diagnosis and therapy of upper GI bleeding caused by Mallory Weiss tears, angiodysplasia or Watermelon stomach.
Síndrome de Mallory-Weiss en una embarazada Mallory-Weiss syndrome in a pregnant  [cached]
Dalis Diago Caballero,Roberto García Valdez,Tulio Dariel Arguelles Soria
Revista Cubana de Obstetricia y Ginecolog?-a , 2010,
Abstract: La hemorragia digestiva es una de las principales causas de ingreso hospitalario por enfermedades del tracto gastrointestinal, el Síndrome de Mallory Weiss, causa el 5-10 % de estas hemorragias. Se realizó una revisión bibliográfica a partir de la existencia de un caso obstétrico portadora de una hiperémesis gravídica. La paciente ingresa por hematemesis, la endoscopia concluyó un Síndrome de Mallory-Weiss, mantuvo buen estado hemodinámico, el tratamiento fue conservador y dietético. Dicha entidad, se conoce como desgarro esofágico, frecuente en hombres y causa el 5-10 % de los sangramientos digestivos altos, el diagnóstico es endoscópico, con una resolución espontánea entre 24 y 48 h. Deben prevenirse los cuadros eméticos y el alcoholismo. En ocasiones puede tener complicaciones extradigestivas. No se diagnostica con mayor frecuencia pues se difiere en muchos casos el estudio endoscópico. The digestive hemorrhage is one of the main causes of hospital entrance for illnesses of the gastrointestinal tract, the Syndrome of Mallory Weiss, causes 5-10 % of these hemorrhages. One carries out a bibliographical revision on the syndrome of Mallory - Weiss starting from the existence of a case obstetric carrier of a hyperemesis pregnancy, being revised this patient's clinical history thoroughly. I develop: The patient enters in the HDCQ Miguel Enríquez for hematemesis, the endoscopy was positive with I diagnose of laceration esofágical for what you/they concluded a Syndrome of Mallory - Weiss, later went you transfer the HDMI 10/October, at every moment it maintained good hemodynamic state and alterations didn't exist in the studies hemoquimicals its treatment it was conservative and dietary, evolving favorably until he/she decided the high one. On this entity, he/she is carried out an outline in the biography of their describers, as well as their definition: I tear esofágical, epidemiology: frequent in men and it causes 5-10% of the high digestive bleedings, the etiology he/she has factors that propitiate like vomits, the clinical square characterizes it the hematemesis, the one diagnoses it is endoscopic with a spontaneous resolution between 24 and 48 hours. It should be prevented the emetic squares and to avoid the alcoholism. In occasions he/she can have complications extradigestives. It is not diagnosed with more since frequency it is differed in many cases the endoscopic study.
Acute upper gastrointestinal bleeding  [PDF]
Jovanovi? I.R.,Popovi? D.,?uranovi? S.,Pavlovi? A.R.
Acta Chirurgica Iugoslavica , 2007, DOI: 10.2298/aci0701021j
Abstract: Aims: Acute upper gastrointestinal bleeding is the commonest emergency managed by gastroenterologist. Our aim was to assess the frequency of erosive gastropathy as a cause of upper GI bleeding as well as its relation to age, gender and known risk factors. Material and methods: We conducted retrospective observational analysis of emergency endoscopy reports from the files of Emergency Department of Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia, during the period from 2000-2005. Data consisted of patients’ demographics, endoscopic findings and potential risk factors. Results: During the period 2000-2005. Three thousandnine hundred and fifty four emergency upper endoscopies were performed for acute bleeding. In one quarter of cases acute gastric erosions were the actual cause of bleeding. One half of them were associated with excessive consumption of salicilates and NSAIDs. In most of the examined cases bleeding stopped spontaneously, while in 7.6% of the cases required endoscopic intervention. Conclusion: Erosive gastropathy represents significant cause of upper gastrointestinal bleeding count up to one quarter of all cases required emergency endoscopy during the 5- year period. Consumption of NSAIDs and salicilates was associated with erosive gastropathy in almost one half of cases (46%) leading us with a conclusion that we must explore other causes of erosive gastropathy more thoroughly.
UPPER GASTROINTESTINAL BLEEDING
JAVED IQBAL
The Professional Medical Journal , 2004,
Abstract: Objective: To determine incidence of different causes of upperGastrointestinal (UGI) bleeding in reference to UGI endoscopy in one hundred patients and to comparethe results with similar studies conducted globally. Design: Prospective, comparative study. Place andduration of Study: The department of medicine, Combined Military Hospital Peshawar during theperiod of one year from June 2002 to June 2003. Patients and Methods: First consecutive one hundredpatients were selected with symptoms and signs of UGI bleeding and endoscopy was performed within48 hours of start of symptoms. Results of the study were compared with similar studies conducted atother centers in Pakistan and abroad. Results: Major cause of UGI bleeding was found to be esophagealvarices (39%) followed by duodenal ulcer (19%), gastric ulcer (9%), superficial mucosal lesion (20%),neoplasia (4%). In 9% patients no cause of UGI bleeding was found on endoscopy. Conclusion: Majorcause of UGI bleeding in our set up is esophageal varices while peptic ulcer is less common comparedwith western world. This reflects high prevalence of chronic liver disease due to viral hepatitis.
Síndrome de Mallory-Weiss en una embarazada
Diago Caballero,Dalis; García Valdez,Roberto; Arguelles Soria,Tulio Dariel;
Revista Cubana de Obstetricia y Ginecolog?-a , 2010,
Abstract: the digestive hemorrhage is one of the main causes of hospital entrance for illnesses of the gastrointestinal tract, the syndrome of mallory weiss, causes 5-10 % of these hemorrhages. one carries out a bibliographical revision on the syndrome of mallory - weiss starting from the existence of a case obstetric carrier of a hyperemesis pregnancy, being revised this patient's clinical history thoroughly. i develop: the patient enters in the hdcq miguel enríquez for hematemesis, the endoscopy was positive with i diagnose of laceration esofágical for what you/they concluded a syndrome of mallory - weiss, later went you transfer the hdmi 10/october, at every moment it maintained good hemodynamic state and alterations didn't exist in the studies hemoquimicals its treatment it was conservative and dietary, evolving favorably until he/she decided the high one. on this entity, he/she is carried out an outline in the biography of their describers, as well as their definition: i tear esofágical, epidemiology: frequent in men and it causes 5-10% of the high digestive bleedings, the etiology he/she has factors that propitiate like vomits, the clinical square characterizes it the hematemesis, the one diagnoses it is endoscopic with a spontaneous resolution between 24 and 48 hours. it should be prevented the emetic squares and to avoid the alcoholism. in occasions he/she can have complications extradigestives. it is not diagnosed with more since frequency it is differed in many cases the endoscopic study.
Upper gastrointestinal bleeding in chronic pancreatitis  [PDF]
BP Kandel,B Ghimire,PJ Lakhey,UK Shrestha,M Khakurel
Journal of Institute of Medicine , 2010, DOI: 10.3126/joim.v32i2.4946
Abstract: Pseudoaneurysm of peripancreatic vessels is a rare complication of chronic pancreatitis. Being close to the pancreas, splenic artery is the most frequently affected vessel whereas right gastroepiploic artery pseudoaneurysm is very rare. Rupture of such pseudoaneurysm is a rare cause of upper gastrointestinal (GI) bleeding. We report a patient of chronic pancreatitis with past history of pancreatic duct stenting who presented with massive upper GI bleeding and stent migration. Bleeding from pseudoaneurysm of right gastroepiploic artery was detected in angiography. Coil embolization was done but later rebleeding occurred and was managed with laparotomy and ligation of the pseudoaneurysm. Patient improved during postoperative period.
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