Controlled Trial of Y AG Laser Treatment of Upper Digestive Hemorrhage
|
|
- Ross Boone
- 6 years ago
- Views:
Transcription
1 GASTROENTEROLOGY 1982;83:410-6 Controlled Trial of Y AG Laser Treatment of Upper Digestive Hemorrhage P. RUTGEERTS, G. VANTRAPPEN, L. BROECKAERT, J. JANSSENS, G. COREMANS, K. GEBOES, and P. SCHURMANS Departments of Medicine and of Medical Research, University Hospitals of Leuven, Leuven, Belgium A trial of neodymium-yttrium-aluminum-garnet laser treatment was conducted in 152 patients with upper gastrointestinal hemorrhage. Laser photocoagulation was applied in 0.5- to l-s pulses of W power. A first part of the trial studying patients with arterial bleeding was uncontrolled. Spurting arterial bleedings could be stopped in 87% of the 23 patients with acute arterial hemorrhage. The recurrence rate after endoscopic treatment of this type of bleeding was high (55%). The operation rate of 61% was, however, lower than the operative indications amounting to 95% in patients with arterial spurters admitted previously to our department. One hundred twenty-nine patients were included in a controlled randomized trial of laser photocoagulation. In 86 patients with active, nonspurting bleeding, the laser was significantly better (p < 0.001) at stopping the bleeding than conservative treatment in randomized controls, and there was a numerical although not significant reduction of the rate of bleeding recurrence and the necessity for surgery (both p < 0.1). In 43 patients with fresh stigmata of bleeding (i.e., fresh clot or visible vessel) laser treatment resulted in a numerical reduction in the rate of rebleeding and in the operative indications, but the difference did not reach statistical significance. The mortality rates were not influenced in any of the groups. The overall mortality rate of acute upper gastrointestinal hemorrhage amounts to approximately 10% (1), ranging from 3.8% to 17% in large series (2,3). The mortality of severe gastrointestinal bleeding in highrisk patients-e.g., patients with multiple internal diseases, poly traumatism, or extensive burns-is much higher (4). Upper gastrointestinal (GI) endos- Received July 29, Accepted April 2, Address requests for reprints to: Professor Dr. G. Vantrappen, Department of Internal Medicine, A.Z. St. Rafael, Kapucijnenvoer 35, B-3000 Leuven, Belgium by the American Gastroenterological Association /82/ $02.50 copy has not altered the mortality of upper digestive hemorrhage (5-7). Early endoscopy allows by its accurate diagnostic yield a better choice of appropriate treatment, because specific bleeding lesions or stigmata (8,9) can be identified that are associated with a high probability of recurrent or uncontrollable bleeding. Endoscopic hemostatic techniques (10) could eventually improve the outcome of GI bleeding. Laser treatment seems to be one of the most promising hemostatic methods. Experiments using the "ulcer model" (11) have shown that both the neodymi um-yttri um-aluminum -garnet (neodymium-y AG) laser (12-18) and the argon laser (14,15,19-21) can be used efficiently and safely to stop ulcer bleeding in animals. Although uncontrolled studies with lasers (12,22-24) showed high efficacy in stopping gastrointestinal bleeding in humans, only controlled randomized studies can elucidate the influence of laser treatment on the natural history, the morbidity, and the mortality of bleeding. An effective, lasting, and safe nonoperative form of therapy of GI bleeding should indeed result in a reduced mortality rate in patients that are at high operative risk, and it could also reduce the duration of hospital admissions for GI bleeding as well as the average cost. However, controlled data on the value of laser treatment are scarce (25-27). The aim of this study was to evaluate the efficacy and the safety of neodymium-yag laser photocoagulation to stop upper GI bleeding or to prevent recurrence of bleeding, or both, in order to reduce the operation and the mortality rate in patients with upper GI bleeding. Patients with arterial spurters were studied by an uncontrolled trial. The results of laser in patients with active nonspurting bleeding and inactive bleeding with fresh stigmata were evaluated by a controlled, randomized study. Methods All patients with upper digestive hemorrhage admitted to the GI unit of the University Hospital during the
2 August 1982 Y AG TREATMENT OF UPPER GI HEMORRHAGE 411 past 3 yr underwent a diagnostic endoscopy within the first 12 h of admission. Those patients in whom the bleeding lesions could be visualized and for whom laser therapy was technically possible were included in a prospective study. They were divided into three groups. Group 1 consisted of patients with spurting arterial bleeding. The study design was submitted to the ethical committee of the hospital. Aware of the excellent results by Kiefhaber et al. (22) in severe GI bleeding, we were not allowed to randomize severely ill patients with arterial spurters for treatment. The risk of prolonging the duration of the endoscopy for laser therapy under close monitoring was considered to be less than the risk of an eventual operation. The committee felt that significant results could be obtained in this group without randomization. Therefore, all patients with arterial bleeding were treated by laser. A randomized trial was conducted in patients with active, nonspurting bleeding and in patients with inactive bleeding with fresh stigmata. Group 2 consisted of 86 patients with active bleeding, in whom arterial spurting could not be visualized. The 43 patients of group 3 did not bleed actively at the time of diagnostic endoscopy, but they did present with a stigma of fresh bleeding, i.e., a red clot or a visible vessel in the base of the ulcer. Patients of groups 2 and 3 were treated at random either by laser or by conservative means. Inclusion in the study and randomization were carried out during the diagnostic endoscopy. When the lesion was visualized and laser treatment was possible, patients were assigned by chance to laser treatment or conservative treatment alone. When the lesions diagnosed at endoscopy met with the study criteria, a nurse selected a card in a sealed envelope out of a box containing 70 cards marked with A (laser) and 70 cards marked with B (control). The card was then removed from the box. Laser treatment was then performed or the endoscopy was ended. Although bleeding in patients of group 1 was always severe, the degree of bleeding in patients of groups 2 and 3 was labeled "severe" if the acute transfusion need exceeded 5 U of blood or if the patient was admitted in shock. Other bleedings were classified as "mild." Laser Apparatus A neodymium-yag-iaser was used (Medilas MBB). delivering a power of 90 W. In the first part of the study (inclusion of 68 patients), the triconial quartz Nath fiber (28), introduced into the small biopsy channel of a double-channel Olympus gastroscope TGF-2D (Olympus Corporation of America, New Hyde Park, N.Y.), was used for transmission of the laser power. In patients with very severe bleeding, a diagnostic upper GI endoscopy was performed under general anesthesia and intubation by means of a small-caliber scope, usually GIF-Q (Olympus), was immediately followed by the introduction of the largecaliber TGF-2D gastroscope (Olympus) for the therapeutic part of the treatment. A new flexible fiber with coaxial CO 2 jet became available later in the course of the study. This fiber can be introduced into any routine endoscope. For laser treatment, however, the double-channel Olympus gastroscope XGIF-2T was used, which is particularly suitable for operative endoscopy. This small-caliber scope was always used for the diagnostic as well as the therapeutic part of the endoscopy. Treatment Modalities Treatment modalities to achieve maximal efficacy and safety were derived from previous animal studies (17). The exact output of laser power at the top of the fiber delivered with different amperages was not constant, but depended on the status of the laser apparatus and the quality of the fiber. The laser power was measured before each laser application. In the beginning of the study, due to imperfect adjustment of the laser and the use of the Nath fiber (which has a limited efficacy of power transmission), a maximal power of W was obtained at the top of the fiber and this power was used for laser therapy. With better adjustment of the laser and the use of the new coaxial CO 2 jet fiber, a laser power of W was obtained and used for treatment. Short laser pulses of 0.5 s or 1 s were applied. The duration of the pulses was limited electronically. In order to minimize the risk for transmural injury, patients were only treated once. The lesions were cleaned by water. A low-pressure coaxial CO 2 jet (200 mll min) was used only to keep the fiber clear; a high-pressure CO 2 jet was not used. In patients with severe bleeding and in high-risk patients, intubation and general anesthesia were performed in order to prevent pulmonary complications by aspiration during the procedure. In most patients, stomach cleansing with ice-cold saline was carried out by means of a large-bore gastric tube (Rosch). Lesions Treated All lesions in the esophagus, stomach, and duodenum in reach of the endoscope were treated except for esophageal and fundic varices or diffuse hemorrhagic lesions of the stomach or esophagus. Follow-Up of the Patients The follow-up of the patients and the decision to operate were the responsibility of one physician not aware of the endoscopic maneuvers. The conservative management of treated and untreated patients after endoscopy was identical and consisted of blood transfusion, parenteral alimentation, cimetidine (200 mg intravenously every 6 h), and correction of coagulation disorders. After the endoscopy, a stomach tube was placed in every patient. Continued bleeding was assessed by aspiration of fresh blood or by unequivocal clinical signs of bleeding (e.g., in duodenal ulcer) over a 24-h period, necessitating continuous blood transfusion. Recurrent bleeding was defined as upper GI bleeding occurring between 1-7 days after the first bleeding episode, thus necessitating a new blood transfusion. Recurrence of bleeding was always objectivated by a new endoscopic examination or by surgery. The physician responsible for the management was informed about the findings of the second endoscopic examination
3 412 RUTGEERTS ET AL. GASTROENTEROLOGY Vol. 83, No.2 but not about the type of previous treatment. Every operative decision was individualized, but it was based on generally accepted criteria. Continued bleeding or recurrence of bleeding were considered sufficient cause for immediate surgery only if a transfusion of >4 U of blood in a 24-h period was necessary or if the patient presented cardiovascular collapse. All patients who died in the course of the study underwent a careful necropsy with special attention for the treated lesions. In the mortality rates, all causes of death occurring after treatment are included, although it is obvious that not all these deaths are hemorrhage related (e.g., peritonitis by shot wounds). Results Between July 1978 and August 1981, 338 patients were admitted for upper digestive hemorrhage. One hundred eighty-six of them were excluded from the trial because of the nature of the lesion they presented with, i.e., diffuse hemorrhagic gastritis or duodenitis (30), bleeding esophageal varices (65), and lesions without fresh stigmata of bleeding (63). In addition, 20 patients could not be treated because of technical defects in the laser apparatus (mostly during the initial part of the trial). Only 8 patients were excluded in spite of the presence of a suitable bleeding lesion in the duodenum; in these patients, either the site of hemorrhage could not be reached by the endoscope, or the bleeding was too severe to permit adequate cleansing of the stomach or duodenum. Ninety-four out of the 152 patients studied (62%) had underlying diseases. Cardiovascular disease was the main disease in 20%, hepatic or pancreatic disease in 22%, neurologic or psychiatric disease in 7%, neoplastic disease in 8%, chronic lung disease in 6%, burns or poly traumatism in 3%, hematologic disease in 2%, metabolic disease in 2%, and chronic inflammatory bowel disease in 0.7%. In 15% of the patients multiple diseases occurred together. Only 47% of all patients had a history of gastroduodenal disease; 18% had a history of previous hemorrhage. The results of treatment in the 152 patients are summarized below. Group 1 All 23 patients (16 males and 7 females; mean age 59 yr; range, yr) presenting with spurting arterial bleeding were treated by laser. The bleeding ulcer was localized in the stomach in 13 patients and in the duodenum in 10 patients. In 20 patients (87%), the bleeding could be stopped by laser. On average, 30 pulses were applied (range, 6-60). The hemostasis was permanent in 9 of the 20 patients (45%) whereas 11 of the 20 patients (55%) had recurrent hemorrhage after an interval of 1-36 h (mean, 12 h). Fourteen of the 23 patients (61%) had to be operated on. The overall mortality in the group of arterial spurters amounted to 7 out of 23 (30%). The cause of death was uncontrollable recurrence of bleeding after surgery in 2 patients, uncontrollable shock in 1 patient, and renal and hepatic failure in a fourth patient (in whom the bleeding had been permanently stopped by laser). Other causes of death were hepatic encephalopathy in 1 patient, bronchopulmonary complications in 1 patient, and cardiac infarction in 1 patient. Five patients had taken antiinflammatory drugs; 9 patients had a decreased Quick test or thrombocyte count. In this group 74% of the patients (17) had underlying diseases. Patients Submitted to Randomization for Treatment Treated and nontreated groups were well matched as to the age of the patients, the severity of bleeding, the presence of underlying diseases, and the presence of factors predisposing to bleeding, i.e., coagulation disorders and the intake of antiinflammatory drugs (Table 1). Data on the bleeding sources in the different treatment groups are summarized in Table 2. Group 2 Eighty-six patients were included in this group. The results of the treatment are summarized in Table 3. In 46 patients, 70 actively bleeding lesions were treated by laser. In all 46 patients the bleeding was controlled by 2-35 laser pulses (mean, 14). The control group consisted of 40 patients in whom 60 lesions were left untreated. Significantly more patients continued to bleed in the non treated group than in the laser group and there was a numerical reduction of rebleeding after initial hemostasis as well as a reduction of the operation rate (both p < 0.1) by laser therapy. The overall mortality rate was identical in both groups. Causes of death in the laser group were: recurrence of bleeding after surgery (1 patient), shock lung (1 patient), peritonitis secondary to abdominal shot wounds (1 patient), cholangitis and sepsis (1 patient), and mesenteric infarction (1 patient). Causes of death in the control group were: uncontrollable bleeding (2 patients), complications after surgery (2 patients), septic shock (1 patient), and cerebrovascular accident (1 patient). It may be noted that three of the surgically treated ulcers in the control group showed an arterial pumper at operation, while at endoscopy only active nonspurting bleeding had been found. All patients on whom surgery was performed had presented with severe bleeding.
4 August 1982 YAG TREATMENT OF UPPER GI HEMORRHAGE 413 Table 1. Comparison of Treatment Groups Number enrolled Male/female Mean age Q Severe bleeding Antiinflammatory drugs or coagulation disorders Underlying diseases Q Age range given in parentheses. Group 2 Group 3 Laser Control Laser Control /18 22/18 5/12 14/12 63 (19-84) 54 (33-78) 59 (21-72) 62 (19-84) 20 (44%) 13 (32%) 14 (82%) 16 (62%) 24 (52%) 20 (50%) 5 (29%) 10 (38%) 29 (63%) 25 (62%) 10 (59%) 13 (50%) Group 3 Forty-three patients were included in this group. The results are summarized in Table 4. Seventeen lesions in 17 patients, were treated by laser. The lesions contained a visible vessel in 6 patients and a fresh clot in 11 patients. The number of laser pulses applied varied from 3 to 61 (mean, 24). In 3 patients arterial spurting occurred after the first laser pulse, but the bleeding could be controlled by continued laser therapy in 2 patients. In 1 patient the bleeding could not be controlled, and in 2 patients the bleeding recurred. In 26 patients, 26 lesions (Le., 4 visible vessels and 22 fresh clots) were left untreated. The recurrence rate of bleeding was reduced by laser therapy as well as the operative indications, although this reduction was insignificant. Overall mortality was insignificantly lower in the laser group. Causes of death in the laser group were: postoperative complications in 1 patient and exsanguination in 1 patient. Causes of death in the control group were: bleeding recurrence and shock in 2 patients, alcoholic encephalopathy in 1 patient, and cardiac infarction in 1 patient. At surgery, arterial spurters were found in 2 patients in whom bleeding recurred during or after laser treatment and in 4 patients of the control group. In this group, too, all patients that were operated upon had presented with severe bleeding. Complications Severe complications of laser treatment were not observed: in particular no free perforations occurred in the course of the study. Two patients, 1 with a duodenal ulcer and 1 with an antral ulcer, developed a discrete transient increase of serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase after laser therapy. Pulmonary complications were avoided during endoscopy by tracheal intubation in severely bleeding patients and were not more frequent in the treated than the nontreated patients. Discussion The characteristics (29), clinical prognostic factors (30), and diagnostic role of endoscopy in upper GI bleeding (31) have now been well defined. The method or combinations of methods that are effective and safe to treat upper GI bleeding have yet to be determined. Among the methods investigated, laser photocoagulation seems to be the most promising for the treatment of nonvariceal bleeding. The aim of the present studies was to investigate the efficacy of the neodymium-y AG laser in the treatment of upper digestive, nonvariceal hemorrhage. Consequently, the only patients admitted to the Table 2. Bleeding Sources in Patients Randomized for Treatment Active bleeding Inactive bleeding (n = 86) (n = 43) Laser Control Laser Control Lesions Patients Lesions Patients Lesions Patients Lesions Patients Stomach ulcers or erosions Duodenal ulcers or erosions Mallory-Weiss tears Esophageal ulcers Stoma ulcers Stomach angiomas 6 1 Stomach carcinoma 1 1 Total
5 414 RUTGEERTS ET AL. GASTROENTEROLOGY Vol. 83, No.2 Table 3. Results in Group 2Q Gastric and duodenal ulcerative lesions Laser Control p Laser No. of patients Bleeding stopped < Bleeding recurred 2/38 5/25 <0.1 1/8 Operation 1 4 <0.2 0 Overall mortality Q Active, nonspurting bleeding. study were those in whom laser therapy was thought to be technically possible during diagnostic endoscopy. Treatment failures therefore were directly related to the inefficacy of laser photocoagulation and not to shortcomings of the endoscopic techniques, e.g., lesions that could not be approached due to severe bleeding or lesions that were out of reach of the endoscope. Such endoscopic failures occurred in 5% of the patients fulfilling the other inclusion criteria. This is in contrast with some other studies (25,26) in which randomization was carried out before endoscopy. The failure rate in these circumstances is a combination of endoscopic and laser failures. All failures in the present series were fundamental failures of the Y AG laser or of the modalities of its application. Only lesions that are known to be associated with a high incidence of continuing bleeding or recurrence of bleeding were selected for treatment, i.e., active (spurting or oozing) bleeding and lesions with fresh stigmata of bleeding. Patients with bleeding varices were electively treated by sclerotherapy. Patients with lesions without fresh stigmata of bleeding at diagnostic endoscopy were not included in the study. Recurrence occurred in 5 out of 63 patients (8%) of this group. Laser was not used when the bleeding was diffuse or when too many bleeding lesions were present (>10 patients). The patients of the present prospective study were divided into three treatment groups according to the findings of the diagnostic endoscopy. Patients in whom arterial spurting was seen at endoscopy were always treated by laser. Although the success rate of the laser in stopping arterial bleeding was high Table 4. Results in Group 3 Q Gastric and duodenal ulcerative lesions Laser Control No. of patients Bleeding recurred 3 7 Operation 2 5 Overall mortality 2 3 Q Inactive bleeding with fresh stigmata. Other lesions Total Control p Laser Control p (100%) 31 (77%) < /6 3/46 (7%) 6/31 (20%) < (2%) 5 (13%) < (13%) 6 (15%) (87%), the recurrence rate of bleeding amounted to more than one-half of the successfully treated patients and 61% of the patients with arterial spurters that required surgery. Compared with patients with arterial spurters admitted to our department in the years preceding the use of the YAG laser, laser treatment resulted in a decrease from 95% to 61% in the indications for surgery. The mortality in this group was not influenced by laser treatment. The main problem in the endoscopic laser treatment of gastroduodenal arterial bleeding, therefore, is not the initial hemostasis, but rather the prevention of recurrent bleeding. Further studies are required to determine whether laser photocoagulation must be stopped as soon as the bleeding has stopped or whether additional laser pulses should be appliedwhich, however, may increase the risk of rebleeding during therapy and of perforation. Patients randomized for treatment had either active nonspurting bleeding lesions, or lesions with fresh stigmata that no longer bled at the time of endoscopy. The latter patients were included in the study because it has been shown that fresh stigmata of bleeding predict rebleeding (8) and that in the case of visible vessels, uncontrollable bleeding or recurrent bleeding may occur in 100% of the patients (9) and always necessitates an operative procedure. Although in patients with arterial bleeding (group 1) and with visible vessels or fresh clots (group 3) a single lesion was always identified as the cause of bleeding, in patients with active bleeding, multiple bleeding lesions were identified in 25% of the patients. This study showed clearly that laser photoco- Mallory-Weiss tears Total Laser Control Laser Control (18%) 8 (31%) (12%) 6 (23%) (12%) 4 (15%)
6 August 1982 YAG TREATMENT OF UPPER GI HEMORRHAGE 415 agulation was significantly (p < 0.001) better at stopping the hemorrhage in patients with active nonspurting bleeding than conservative treatment alone. Moreover, laser treatment tended to reduce the rate of bleeding recurrence and the necessity for surgery in these patients. In patients with fresh stigmata of bleeding, laser treatment occasionally induced acute arterial bleeding (in 3 patients with visible vessels), perhaps due to the direct application of photocoagulation on the visible vessel. In 1 patient, the resulting bleeding could not be stopped. In this group, laser treatment reduced both the rate of rebleeding and the operative indications, although not significantly. Papp et al. (32) were able to show significant differences in rebleeding of visible vessels in a small number of patients using monopolar electrocoagulation. Vallon et al. (27) randomized 108 nonbleeding ulcers to prophylactic argon-laser photocoagulation or sham treatment. No differences were noted in the rate of rebleeding, operation, or mortality in these groups. Bown et al. (33) treated 19 patients with visible vessels by argon laser photocoagulation. The rate of rebleeding of 9 out of 19 was equal to the rate of reb lee ding in a control group (9 out of 20). Visible vessels as described by Griffith et al. (9) occurred in only 10 out of 338 (3%) diagnostic endoscopies for upper GI bleedings in the present series. It has been recognized for a long time that recurrent bleeding is often severe. In this study, 69% of the active, nonspurting lesions or of the lesions with fresh stigmata that rebled or continued to bleed turned out to have changed to spurting arterial hemorrhages when surgery had to be carried out for recurrence of bleeding. This finding suggests that the main problem in the endoscopic control of upper digestive hemorrhage lies in the treatment of arterial bleeding. In conclusion, the present studies show that YAGlaser photocoagulation effectively stops upper GI hemorrhage in 87%-100% of the patients. In active bleeding, the laser is efficient to stop the bleeding, and laser treatment tends to prevent recurrence of bleeding and to lower the operation rate. Applied as described in this paper, the laser is safe. The main problem still is the treatment of severe arterial bleeding. This treatment can be improved in several ways: (a) The endoscopic technique should be improved so that all lesions can be approached. (b) The efficacy of laser treatment could be enhanced by repeated treatment-which, however, increases the risk of transmural injury. (c) Identification of those arterial bleedings that are likely to recur after laser photocoagulation could lead to more selective and more elective surgery. References 1. Schiller KFR, Cotton PB. Acute upper gastrointestinal haemorrhage. Clin Gastroenterol 1978;7: Cotton PM, Rosenberg MT, Waldram RLP, et al. Early endoscopy of the oesophagus, stomach and duodenal bulb in patients with hematemesis and melena. Br Med J 1973;2: Cello JP. Thoeni RF. Gastrointestinal hemorrhage. Comparative values of double-contrast upper gastrointestinal radiology and endoscopy. JAMA 1980;243: Thorne FL, Nyhus LM. Treatment of upper gastrointestinal hemorrhage: a ten-year review. Am Surg 1965;31: Winans GS. Emergency upper gastrointestinal endoscopydoes haste make waste? Am J Dig Dis 1977;22: Dronfield MW, Mc Illmurray MB, Ferguson R, et al. A prospective randomised study of endoscopy and radiology in acute upper gastrointestinal tract bleeding. Lancet 1977; i: Allan R, Dykes P. A comparison of routine and selective endoscopy in the management of acute gastrointestinal haemorrhage. Gastrointest Endosc 1974;20: Foster DN, Miloszewski KJA, Losowsky MS. Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding. Br Med J 1978;1: Griffith WI. Neumann DA, Welsh JD. The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med 1979;300: Katon RM. Experimental control of gastrointestinal hemorrhage via the endoscope: a new era dawns. Gastroenterology 1976;70: Protell RL, Silverstein FE, Piercey I. et al. A reproducible animal model of acute bleeding ulcer-the "ulcer marker." Gastroenterology 1976;71: Kiefhaber P, Nath G, Moritz K. Endoscopical control of massive gastrointestinal hemorrhage by irradiation with a high-power neodymium-yag laser. Prog Surg 1977;15: Dixon JA, Berenson MM, McCloskey DW. Neodymium-YAG laser treatment of experimental canine gastric bleeding. Gastroenterology 1979;77: Friihmorgen p, Kaduk B, Reidenbach HD. et al. Vergleichende Untersuchungen zur Fiberendoskopische Lichtkoagulation mit Argon-ionen und einen Neodymium Yag-laser. In: Fortschritte der gastroenterologischen Endoskopie. Baden Baden:Witzrock 1970: Silverstein FE. Protell RL. Gilbert DA. et al. Argon vs. neodymium YAG laser photocoagulation of experimental canine gastric ulcers. Gastroenterology 1979;77: Bown SG. Salmon PRo Storey DW, et al. Nd YAG laser photocoagulation in the dog stomach. Gut 1980;21: Rutgeerts p, Vantrappen G, Geboes K. et al. Safety and efficacy of neodymium-y AG laser photocoagulation: an experimental study in dogs. Gut 1981;22: Geboes K, Rutgeerts p. Vantrappen G. et al. A microscopic and ultrastructural study of hemostasis after laser photocoagulation. Gastrointest Endosc 1980;26: Silverstein FE, Auth DC. Rubin CE, et al. High power argon laser treatment via standard endoscopes. Gastroenterology 1976;71: Silverstein FE. Protell RL. Piercey J. et al. Comparison of the efficacy of high and low power photocoagulation in control of severely bleeding experimental ulcers in dogs. Gastroenterology 1977;73: Bown SG. Salmon PRo Kelly DF, et al: Argon laser photocoagulation in the dog stomach. Gut 1979;20:680-7.
7 416 RUTGEERTS ET AL. GASTROENTEROLOGY Vol. 83, No Kiefhaber p, Moritz K, Schildberg FW, et al. Endoskopische Nd-YAG laser Koagulation blutender akuter und chronische Ulcera. Langenbecks Arch Chir 1978: Friihmorgen P, Bodem F, Reidenbach HD, et al. Endoscopic laser coagulation of bleeding gastrointestinal lesions with report of the first therapeutic application in man. Gastrointest Endosc 1976;23: Laurence BH, Vallon AG, Cotton PB, et al. Endoscopic laser photocoagulation for bleeding peptic ulcers. Lancet 1980; 1: Rohde H, Thorr K, Fischer M, et al. Early endoscopy combined with endoscopic neodymium-y AG laser therapy in patients with actively bleeding lesions. Abstracts of the IV European Congress of G.1. Endoscopy, E 30.3, 107, Escourrou J. Etude du laser YAG dans les hemorrhagies digestives. Etude prospective et randomisee. Resultats preliminaires. Paper presented at the IV Congres Europeen d'endoscopie Digestive, Hambourg, Juin Personal communication. 27. Vallon AG, Cotton PB, Laurence BM, et al. Randomized trial of endoscopic laser photocoagulation in bleeding peptic ulcers. Gut 1981;22: Nath G, Gorisch W, Kiefhaber P. First laser endoscopy via a fibroptic transmission system. Endoscopy 1973;5: Silverstein FE, Gilbert DA, Tedesco FJ, et al. The national ASGE survey on upper gastrointestinal bleeding. I. Study design and baseline data. Gastrointest Endosc 1981;27: Silverstein FE, Gilbert DA, Tedesco FJ, et al. The national ASGE survey on upper gastrointestinal bleeding. II. Clinical prognostic factors. Gastrointest Endosc 1981;27: Gilbert DA, Silverstein FE, Tedesco FJ, et al. The national ASGE survey on upper gastrointestinal bleeding. III. Endoscopy in upper gastrointestinal bleeding. Gastrointest Endosc 1981;27: Papp JP. Endoscopic electrocoagulation of the nonbleeding visible ulcer vessel. Gastrointest Endosc 1979;25: Bown SG, Storey DW, Swain P, et al. Controlled trial of argon laser photocoagulation for haemorrhage from peptic ulcers. Gut 1981;22:A414.
Upper Gastrointestinal Bleeding Among Saudis: Etiology And Prevalence The Riyadh Central Hospital Experience
Upper Gastrointestinal Bleeding Among Saudis: Etiology And Prevalence The Riyadh Central Hospital Experience Mohammed Al-Mofarreh, Facharzt; Yisa M. Fakunle, MD, FRCP (London); Mohammed Al-Moagel, Facharzt
More informationMultipolar Electrocoagulation in the Treatment of Peptic Ulcers with Nonbleeding Visible Vessels
Multipolar Electrocoagulation in the Treatment of Peptic Ulcers with Nonbleeding Visible Vessels A Prospective, Controlled Trial Loren Laine, MD Study Objective: To assess the efficacy and safety of treatment
More informationEndoscopic Prediction of Major Rebleeding-A Prospective Study of Stigmata of Hemorrhage in Bleeding Ulcer
GASTROENTEROLOGY 1985;88:1209-14 Endoscopic Prediction of Major Rebleeding-A Prospective Study of Stigmata of Hemorrhage in Bleeding Ulcer pal WARA Surgical Gastroenterological Department, Aarhus Municipal
More informationstatin depresses pancreatic endocrine'6 and small scale trials where somatostatin has been used in the treatment of upper gastrointestinal bleedings
Gut, 1985, 26, 221-226 Alimentary tract and pancreas Randomised double blind trial of somatostatin in the treatment of massive upper gastrointestinal haemorrhage I MAGNUSSON, T IHRE, C JOHANSSON, U SELIGSON,
More informationA bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk?
Focus on CME at the University of British Columbia A bleeding ulcer: What can the GP do? By Robert Enns, MD, FRCP Gastrointestinal bleeding is a relatively common disorder affecting thousands of Canadians
More informationUGI Bleeding: Impact and Outcome of Early Endoscopy at the Referral Community Hospital ABSTRACT
Original Article Jewsuebpong T THAI J GASTROENTEROL 2008 Vol. 9 No. 2 May - Aug. 2008 67 UGI Bleeding: Impact and Outcome of Early Endoscopy at the Referral Community Hospital Jewsuebpong T ABSTRACT Background:
More informationprospective, randomised controlled trial
Gut, 1990,31,753-757 Division of Gastroenterology, Departments of Medicine and Emergency, Veterans General Hospital, Taipei, Taiwan, Republic of China H J Lin F Y Lee W M Kang Y T Tsai S D Lee C H Lee
More information2nd INTERNATIONAL SYMPOSIUM ON LASER SURGERY. laser Phototherapy in Man Using Argon and Neodymium:YAG Lasers
2nd INTERNATIONAL SYMPOSIUM ON LASER SURGERY laser Phototherapy in Man Using Argon and Neodymium:YAG Lasers R.M. Dwyer, M. Bass and E. Van Stryland ~ Department of Medicine, University of California Los
More informationSangrado Gastrointestinal Alto Upper GI Bleeding
Sangrado Gastrointestinal Alto Upper GI Bleeding Curso Internacional Retos Clinicos en la Gastroenterologia de Urgencias Asociacion Colombiana de Gastroenterologia 31 de Agosto, 2012 Pereira, Risaralda
More informationAudit of mortality in upper gastrointestinal bleeding
Postgraduate Medical Journal (1989) 65, 913-917 Medical Audit Audit of mortality in upper gastrointestinal bleeding B.D. Katschinski', R.F.A. Logan2, J. Davies3 and M.J.S. Langman4 'Division of Gastroenterology,
More informationOn-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding
On-Call Upper GI Bleeding John R Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Upper Gastrointestinal Bleeding 300,000000 hospitalizations/year
More informationPerforated peptic ulcer
Perforated peptic ulcer - Despite the widespread use of gastric anti-secretory agents and eradication therapy, the incidence of perforated peptic ulcer has changed little, age limits increase NSAIDs elderly
More informationComparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding
Gut 1999;44:715 719 715 Division of Gastroenterology, Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China H-J Lin G-Y Tseng C-L Perng F-Y Lee F-Y Chang S-D Lee Correspondence
More informationImproved risk assessment in upper GI bleeding
EDITORIAL Improved risk assessment in upper GI bleeding Acute upper GI bleeding is the most common GI emergency, with a reported incidence in various epidemiological studies ranging from 50 to over 100
More informationACG Clinical Guideline: Management of Patients with Ulcer Bleeding
ACG Clinical Guideline: Management of Patients with Ulcer Bleeding Loren Laine, MD 1,2 and Dennis M. Jensen, MD 3 5 1 Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut,
More informationTreatment of Bleeding Canine Duodenal and Esophageal Ulcers with Argon Laser and Bipolar Electrocoagulation
GASTROENTEROLOGY 1981;81:859-65 Treatment of Bleeding Canine Duodenal and Esophageal Ulcers with Argon Laser and Bipolar Electrocoagulation GUSTAVO A. MACHICADO, DENNIS M. JENSEN, JORGE I. TAPIA, and WILLIAM
More informationControlled Study of Different Sclerosing Agents for Coagulation of Cahine Gut Arteries
GASTROENTEROLOGY 1989;96:1274-81 Controlled Study of Different Sclerosing Agents for Coagulation of Cahine Gut Arteries GAYLE M. RANDALL, DENNIS M. JENSEN, KENNETH HIRABA Y ASHI, and GUSTAVO A. MACHICADO
More informationEndoClot PHS A medical application on 74 patients march 2013
EndoClot PHS A medical application on 74 patients march 2013 EndoClot PHS as a new method to achieve hemostasis of gastrointestinal bleeding Evaluation of a medical application involving 74 patients. Introduction
More informationAcute Upper Gastrointestinal Hemorrhage Surgical Perspective. Dr.J.H.Barnard Dept. of Surgery PAH
Acute Upper Gastrointestinal Hemorrhage Surgical Perspective Dr.J.H.Barnard Dept. of Surgery PAH Introduction: AGH is a leading cause of admissions into ICU. Overall mortality 5-12%, but increases to 40%
More informationCOPYRIGHTED MATERIAL. 1 Approach to the patient with gross gastrointestinal bleeding. Grace H. Elta, Mimi Takami
1 Approach to the patient with gross gastrointestinal bleeding Grace H. Elta, Mimi Takami Gastrointestinal (GI) bleeding is a common clinical problem that requires more than 300 000 hospitalizations annually
More informationExperimental Comparison of Endoscopic Yttrium-Aluminum-Garnet Laser, Electrosurgery, and Heater Probe for Canine Gut Arterial Coagulation
GASTROENTEROLOGY 1987;92:111-8 ALIMENTARY TRACT Experimental Comparison of Endoscopic Yttrium-Aluminum-Garnet Laser, Electrosurgery, and Heater Probe for Canine Gut Arterial Coagulation Importance of Compression
More informationThe Role of Endoscopy in the Diagnosis and Management of Upper Gastrointestinal Bleeding.
Original Article ISSN (O):2395-2822; ISSN (P):2395-2814 The Role of Endoscopy in the Diagnosis and Management of Upper Gastrointestinal Bleeding. Faroze A. Khan 1, M. H. Raza 2, Vikrant 1 1 Senior Resident,
More informationInternational Journal of Research in Pharmacology and Pharmacotherapeutics
44 Available Online at: Print ISSN : 2278-2648 Online ISSN: 2278-2656 (Research article) Find out the prevalance of various non-variceal diseases producing upper GI bleeding * 1 N.Junior Sundresh, 2 S.Narendran,
More informationComparison of endoscopic findings in patients from different ethnic groups undergoing endoscopy for upper gastrointestinal bleed in eastern Nepal
Comparison of endoscopic findings in patients from different ethnic groups undergoing endoscopy for upper gastrointestinal bleed in eastern Nepal Jaya Bhattarai, Pramod Acharya, Bipin Barun, Shashank Pokharel,
More informationEMERGENCY ENDOSCOPY IN UPPER GASTROINTESTINAL BLEEDING
EMERGENCY ENDOSCOPY IN UPPER GASTROINTESTINAL BLEEDING Pages with reference to book, From 30 To 33 Huma Qureshi, Najmuddin Banatwala, Sarwar J. Zuberi, S. Ejaz Alam ( PMRC Research Centre, Jinnah Postgraduate
More informationAnticoagulants are a contributing factor. Other causes are Mallory-Weiss tears, AV malformations, and malignancy and aorto-enteric fistula.
Upper GI Bleeding EMU2018 Dr. Walter Himmel MD Incidence: In non-cirrhotics, the commonest causes are peptic ulcer disease (50%) followed by erosive gastritis. In cirrhotic patients, variceal bleeding
More informationDefinitive Surgical Treatment When Endoscopy Fails. Erik Peltz D.O. Resident Debate February 26 th 2007 University of Colorado Dept.
Nonvariceal Gastrointestinal Hemorrhage: Definitive Surgical Treatment When Endoscopy Fails Erik Peltz D.O. Resident Debate February 26 th 2007 University of Colorado Dept. Surgery Non-Variceal Upper GI
More informationEmergency Surgery Course Graz, March UPPER GI BLEEDING. Carlos Mesquita Coimbra
UPPER GI BLEEDING Carlos Mesquita Coimbra Aim Causes Management Problem Above angle of Treitz Common emergency 1-2/1000 pts 10% rebleeed 1% angioembolization 20% over 60
More informationTurning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient
Turning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient John Greenaway 1 Turning off the tap: Endoscopy Answer the questions Benefits and risks of endoscopy Urgency
More informationAetiology Of Upper Gastrointestinal Bleeding In North- Eastern Nigeria: A Retrospective Endoscopic Study
ISPUB.COM The Internet Journal of Third World Medicine Volume 8 Number 2 Aetiology Of Upper Gastrointestinal Bleeding In North- Eastern Nigeria: A Retrospective Endoscopic S Mustapha, N Ajayi, A Shehu
More informationT he aim of a scheduled second endoscopy is to detect and
1403 STOMACH Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial P W Y Chiu, C Y W Lam, S W Lee, K H Kwong, S H Lam, D T Y Lee, S P Y Kwok... See
More informationUpper gastrointestinal bleeding in children. Nguyễn Diệu Vinh, MD Department of Gastroenterology
Upper gastrointestinal bleeding in children Nguyễn Diệu Vinh, MD Department of Gastroenterology INTRODUCTION Upper gastrointestinal (UGI) bleeding : arising proximal to the ligament of Treitz in the distal
More informationValidation of the Rockall risk scoring system in upper gastrointestinal bleeding
Gut 1999;44:331 335 331 Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands E M Vreeburg E A J Rauws JFWMBartelsman GNJTytgat Department of Gastroenterology,
More informationSurgery for Complications of Peptic Ulcer Disease (Definitive Treatment)
Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Amid Keshavarzi, MD UCHSC Grand Round 3/20/2006 Department of Surgery Introduction Epidemiology Pathophysiology Clinical manifestation
More informationGASTROINESTINAL BLEEDING. Dr.Ammar I. Abdul-Latif
GASTROINESTINAL BLEEDING Dr.Ammar I. Abdul-Latif CLASSIFICATION OF G.I.BLEEDING GIB Appearance Acuity Site Apparent Acute Upper Obscure Chronic Lower UPPER&LOWER G.I.BLEEDING CAUSES OF UPPER G.I. BLEEDING
More informationORIGINAL INVESTIGATION
ORIGINAL INVESTIGATION A Prospective Randomized Comparative Trial Showing That Prevents Rebleeding in Patients With Bleeding Peptic Ulcer After Successful Endoscopic Therapy Hwai-Jeng Lin, MD, FACG; Wen-Ching
More informationHydrogen Peroxide Improves the Visibility of Ulcer Bases in Acute Non-variceal Upper Gastrointestinal Bleeding: A Single-Center Prospective Study
Dig Dis Sci (2009) 54:2427 2433 DOI 10.1007/s10620-009-0948-4 ORIGINAL ARTICLE Hydrogen Peroxide Improves the Visibility of Ulcer Bases in Acute Non-variceal Upper Gastrointestinal Bleeding: A Single-Center
More informationClinical Management of Obscure- Overt Gastrointestinal Bleeding. Presented by Dr. 張瀚文
Clinical Management of Obscure- Overt Gastrointestinal Bleeding Presented by Dr. 張瀚文 Definition Obscure: : hard to understand; not clear. Overt: : public; not secret. Occult: : hidden from the knowledge
More informationMcHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2018 #10 Acute GI Bleeds
McHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2018 #10 Acute GI Bleeds Gastrointestinal bleeding is a very common problem in emergency medicine. Between
More informationScottish Medicines Consortium
Scottish Medicines Consortium esomeprazole, 40mg vial of powder for solution for intravenous injection or infusion (Nexium I.V. ) No. (578/09) AstraZeneca 09 October 2009 The Scottish Medicines Consortium
More informationEGD Data Collection Form
Sociodemographic Information Type Zip Code Gender Height (in inches) Race Ethnicity Inpatient Outpatient Male Female Birth Date Weight (in pounds) American Indian (Native American) or Alaska Native Asian
More informationComparison of Argon Laser Photocoagulation and Bipolar Electrocoagulation for Endoscopic Hemostasis in the Canine Colon
GASTROENTEROLOGY 1982;83:830-5 Comparison of Argon Laser Photocoagulation and Bipolar Electrocoagulation for Endoscopic Hemostasis in the Canine Colon DENNIS M. JENSEN, GUSTAVO A. MACHICADO, JORGE TAPIA,
More informationUGI BLEED. Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore
UGI BLEED Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore Outline UGI bleed: etiology and presentation Management: Non variceal / variceal bleed
More informationHistorical perspective
Raj Santharam, MD GI Associates, LLC Clinical Assistant Professor of Medicine Medical College of Wisconsin Historical perspective FFS first widespread use in the early 1970 s Expansion of therapeutic techniques
More informationEndoscopic Management of Vascular Lesions of the GI tract
Endoscopic Management of Vascular Lesions of the GI tract Lake Louise, June 2014 Sergio Zepeda Gómez MD Assistant Professor Division of Gastroenterology University of Alberta, Edmonton Best Practice &
More informationLower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY
Lower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY 15 FEB 2018 Sources Sources Sources Initial evaluation History Physical examination Laboratory evaluation Obtained at
More informationNew Techniques. Incidence of Peptic Ulcer. Changing. Contents - with an emphasis on peptic ulcer bleeding. Cause of death in peptic ulcer bleeding
Contents - with an emphasis on peptic ulcer bleeding New Techniques in Treating GI Bleeding Incidence and cause of death Acid suppression Endoscopic hemostasis Prediction of rebleeding and death Second
More informationComparison of the Effectiveness of Interventional Endoscopy in Bleeding Peptic Ulcer Disease according to the Timing of Endoscopy
Gut and Liver, Vol. 3, No. 4, December 2009, pp. 266-270 original article Comparison of the Effectiveness of Interventional Endoscopy in Bleeding Peptic Ulcer Disease according to the Timing of Endoscopy
More informationClinical Outcomes of Endoscopic Hemostasis for Bleeding in Patients with Unresectable Advanced Gastric Cancer
J Gastric Cancer. 2017 Dec;17(4):374-383 pissn 2093-582X eissn 2093-5641 Original Article Clinical Outcomes of Endoscopic Hemostasis for Bleeding in Patients with Unresectable Advanced Gastric Cancer 2,*
More informationAcute Upper Gastro Intestinal (UGI) Bleeding
T Acute Upper Gastro Intestinal (UGI) Bleeding University Hospitals of Leicester NHS Trust Guidelines for Management of Acute Medical Emergencies 1. Has there been a GI bleed? There are also UHL trust
More informationOutcome of Upper Gastrointestinal Hemorrhage According to the BLEED Risk Classification: a Two-year Prospective Survey
Bahrain Medical Bulletin, Vol. 29, No. 1, March 2007 Outcome of Upper Gastrointestinal Hemorrhage According to the BLEED Risk Classification: a Two-year Prospective Survey Javad Salimi, MD* Ahmad Salimzadeh,
More informationOriginal Article. Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome
Tropical Gastroenterology 2015;36(1):31 35 Original Article Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome Surinder S Rana 1, Vishal Sharma 1, Deepak
More informationUNC HOSPITALS CHAPEL HILL, NORTH CAROLINA REQUEST AND AUTHORIZATION FOR UPPER GASTROINTESTINAL ENDOSCOPY AND BIOPSY MIM#180
UNC HOSPITALS CHAPEL HILL, NORTH CAROLINA 27514 REQUEST AND AUTHORIZATION FOR UPPER GASTROINTESTINAL ENDOSCOPY AND BIOPSY MIM#180 I request and authorize and/or associates or assistants of his/her choice
More informationvolume endoscopic injection of epinephrine for peptic ulcer bleeding
A prospective, randomized trial of large- versus small-, volume endoscopic injection of epinephrine for peptic ulcer bleeding Hwaideng Lin, MD, FACG,Yu-Hsi Hsieh, MD, Guan-Ying Tseng, MD, Chin-Lin Perng,
More informationJames Irwin Gastroenterology Department Palmerston North Hospital. Acute Medicine Meeting Hutt Hospital. June 21, 2015
The Management of Acute Upper Gastrointestinal Bleeding James Irwin Gastroenterology Department Palmerston North Hospital Acute Medicine Meeting Hutt Hospital June 21, 2015 Outline Common Definitions and
More informationInternet Journal of Medical Update
Internet Journal of Medical Update. 2017 July;12(2):4-9. doi: 10.4314/ijmu.v12i2.2 Internet Journal of Medical Update Journal home page: http://www.akspublication.com/ijmu Original Work A clinical study
More informationClinical Endoscopic Parameters of Upper Gastrointestinal Bleeding Hemal Shah, 1 T. P. Manohar 2
Original Article Clinical Endoscopic Parameters of Upper Gastrointestinal Bleeding Hemal Shah, 1 T. P. Manohar 2 1 Junior Resident 2 Associate Professor,Department of Medicine, N.K.P. Salve Institute Of
More informationShou Jiang Tang, MD, FASGE. Director of Endoscopic Research Professor in Medicine
Shou Jiang Tang, MD, FASGE Director of Endoscopic Research Professor in Medicine Through-the-scope clipping devices Over-the-scope clipping devices First reported clipping device Hayshi T, Yonezawa M,
More informationSimon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor
Simon Everett Consultant Gastroenterologist, SJUH, Leeds if this is what greets you in the morning, you probably need to go see a doctor Presentation Audit data and mortality NICE guidance Risk assessment
More informationA Study of the Correlation between Endoscopic and Histological Diagnoses in Gastroduodenitis
000-9 70/8 7/80S-0749 THE AMERICAN JOIIRNAE. OF GAsrR()E.NrER 1987 by Am. Coll.ofGastroenterology Vo!.8. No. 8, 1487 Printed in U.S.A. A Study of the Correlation between Endoscopic
More informationWhich peptic ulcer patients bleed?
Gut, 1988, 29, 70-74 Which peptic ulcer patients bleed? K MATTHEWSON, S PUGH, AND T C NORTHFIELD From the Gastroenterology Units, St James Hospital, Balham and University College Hospital, London SUMMARY
More informationReview article: management of peptic ulcer bleeding the roles of proton pump inhibitors and Helicobacter pylori eradication
Aliment Pharmacol Ther 2004; 19 (Suppl. 1): 66 70. Review article: management of peptic ulcer bleeding the roles of proton pump inhibitors and Helicobacter pylori eradication G. HOLTMANN* & C. W. HOWDEN
More informationBleeding in the Digestive Tract
Bleeding in the Digestive Tract National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH U.S. Department of Health
More informationEffect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical trial
Aliment Pharmacol Ther 2003; 17: 211 216. doi: 10.1046/j.0269-2813.2003.01416.x Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical
More informationUpper Gastrointestinal Bleeding Score for Differentiating Variceal and Nonvariceal Upper Gastrointestinal Bleeding ABSTRACT
44 Original Article Upper Gastrointestinal Bleeding Score for Differentiating Variceal and Jaroon Chasawat Varayu Prachayakul Supot Pongprasobchai ABSTRACT Background: Upper gastrointestinal bleeding (UGIB)
More informationBefore Endoscopy? Indications Thermal Coagulation Injection Therapy Combination Therapy Fibrin Sealant Endoclips Argon Plasma Coagulation Lysine -
Dr Simon Smale Before Endoscopy? Indications Thermal Coagulation Injection Therapy Combination Therapy Fibrin Sealant Endoclips Argon Plasma Coagulation Lysine - Haemmostop Variceal Banding Histoacryl
More informationUpper Gastrointestinal Manifestations in Chronic Renal Failure Through Upper Gastrointestinal Endoscopy
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2017/249 Upper Gastrointestinal Manifestations in Chronic Renal Failure Through Upper Gastrointestinal Endoscopy Madavaram
More informationBritish Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion
British Society of Gastroenterology UK Com parat ive Audit of Upper Gast roint est inal Bleeding and t he Use of Blood Transfusion Extract December 2007 St. Elsewhere's Hospital National Comparative Audit
More informationEsophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph
Esophageal Varices Beta-Blockers or Band Ligation Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation? Risk of esophageal variceal
More informationOriginal Article INTRODUCTION
Original Article Endoscopic treatment for high risk bleeding peptic ulcers: A randomized, controlled trial of epinephrine alone with epinephrine plus fresh Mahsa Khodadoostan, Mohammad Karami Horestani,
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Oakland K, Jairath V, Uberoi R, et al. Derivation
More informationChanges in the Clinical Outcomes of Variceal Bleeding in Cirrhotic Patients: A 10-Year Experience in Gangwon Province, South Korea
Gut and Liver, Vol. 6, No. 4, October 2012, pp. 476481 ORiginal Article Changes in the Clinical Outcomes of Variceal Bleeding in Cirrhotic Patients: A 10Year Experience in Gangwon Province, South Korea
More informationWhen to Scope in Lower GI Bleeding: It Must Be Done Now. Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA
When to Scope in Lower GI Bleeding: It Must Be Done Now Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA Outline Epidemiology Overview of available tests Urgent
More informationEmergency Surgery Board Department of General Surgery Rambam Health Care Campus
Emergency Surgery Board Department of General Surgery Rambam Health Care Campus Surgical Complications of Peptic Ulcer Disease Bleeding Case Presentation and Review of the Literature Case Presentation
More informationProgress in Surgery, Vo1. 15
Progress in Surgery, Vo1. 15 Progress in Surgery Voi. 15 Editors Μ. ΑLLΟ wεr, Basel; S.-E. BERGENrz, Malmö, R. Y. CALΙE, Cambridge; U. F. GRUBER, Basel Contributors F. W. AHIEFELD, Ulm; M. ALLGÖwΕR, Basel;
More informationPeptic ulcers remain the most common cause of upper
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:33 47 STATE OF THE ART Endoscopic Therapy for Bleeding Ulcers: An Evidence-Based Approach Based on Meta-Analyses of Randomized Controlled Trials LOREN LAINE*
More informationRole of Malabsorptive Endoscopic Procedures in Obesity Treatment
FOCUSED REVIEW SERIES: Roles of Bariatric Endoscopy in Obesity Treatment Clin Endosc 2017;50:26-30 https://doi.org/10.5946/ce.2017.004 Print ISSN 2234-2400 On-line ISSN 2234-2443 Open Access Role of Malabsorptive
More informationHemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy
Original article Hemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy Authors Yeong Jin Kim, Jun Chul Park, Eun Hye Kim, Sung Kwan Shin,
More informationGastrointestinal Bleeding in the Elderly: Results from the SOME Bleeding Study
Selective Outpatient Management of Upper Gastrointestinal Bleeding in the Elderly: Results from the SOME Bleeding Study Francisco CebolleroSantamaria, MD, James Smith, MD, Scott Gioe, MD, Timothy Van Frank,
More informationPositioning Biologics in Ulcerative Colitis
Positioning Biologics in Ulcerative Colitis Bruce E. Sands, MD, MS Acting Chief, Gastrointestinal Unit Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Sequential Therapies
More informationSupplementary Online Content
Supplementary Online Content Guimarães PO, Krishnamoorthy A, Kaltenbach LA, et al. Accuracy of medical claims for identifying cardiovascular and bleeding events after myocardial infarction: a secondary
More informationTools of the Gastroenterologist: Introduction to GI Endoscopy
Tools of the Gastroenterologist: Introduction to GI Endoscopy Objectives Endoscopy Upper endoscopy Colonoscopy Endoscopic retrograde cholangiopancreatography (ERCP) Endoscopic ultrasound (EUS) Endoscopic
More informationClinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage
ORIGINAL ARTICLE Clin Endosc 2015;48:380-384 http://dx.doi.org/10.5946/ce.2015.48.5.380 Print ISSN 2234-2400 On-line ISSN 2234-2443 Open Access Clinical Application of AIMS65 Scores to Predict Outcomes
More informationClinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy
ORIGINAL ARTICLE Korean J Intern Med 2016;31:470-478 Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy Dong-Won Ahn 1,2,*, Young Soo Park 1,3,*,
More informationUpper gastrointestinal (GI) bleeding represents a substantial
Clinical Guidelines Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding Alan Barkun, MD, MSc; Marc Bardou, MD, PhD; and John K. Marshall, MD, MSc, for the Nonvariceal
More informationClinical and Endoscopic Features of Peptic Ulcer Bleeding in Malaysia
Clinical and Endoscopic Features of Peptic Ulcer Bleeding in Malaysia * P Kandasami, FRCS, ** K Harjit, FRCS, *** H Hanafiah, FRCS * Department of Surgery, International Medical University, ** Department
More informationA cute upper gastrointestinal haemorrhage is
399 BEST PRACTICE Management of haematemesis and melaena K Palmer... Acute upper gastrointestinal bleeding is a common medical emergency which carries hospital mortality in excess of 10%. The most important
More informationRisk assessment in UGIB: recent PCI & ACS. Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass
Risk assessment in UGIB: recent PCI & ACS Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass Clinical scenario 65 yr male Previous smoker, hyperlipidaemia, DM PCI < 48 hours Dual
More informationChapter 32 Gastroenterology General Pathophysiology General Risk Factors for GI emergencies: Excessive Consumption Excessive Smoking Increased
1 2 3 4 5 6 7 Chapter 32 Gastroenterology General Pathophysiology General Risk Factors for GI emergencies: Excessive Consumption Excessive Smoking Increased Ingestion of Caustic Substances Poor Bowel Habits
More informationLaboratory Technique ROLE OF CAPSULE ENDOSCOPY IN OBSCURE GASTROINTESTINAL BLEEDING
Laboratory Technique ROLE OF CAPSULE ENDOSCOPY IN OBSCURE GASTROINTESTINAL BLEEDING J. JAIN* ABSTRACT Capsule endoscopy (CE) is a safe, non invasive technique for evaluation of small bowel (SB) lesions.
More informationVARICEAL BLEEDING. Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta.
VARICEAL BLEEDING Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta Disclosures: None OUTLINE Pathophysiology of portal hypertension Splanchnic
More informationA randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels
462 Gut 1998;42:462 469 PAPERS GI Science Research Unit, St Bartholomew s and The Royal London School of Medicine and Dentistry, London, UK C C Hepworth S S Kadirkamanathan CPSwain Department of Medical
More informationLong-term Outcome of Patients With Obscure Gastrointestinal Bleeding Investigated by Double-Balloon Endoscopy
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:151 158 Long-term Outcome of Patients With Obscure Gastrointestinal Bleeding Investigated by Double-Balloon Endoscopy SATOSHI SHINOZAKI, HIRONORI YAMAMOTO,
More informationEndoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding
Online Submissions: http://www.wjgnet.com/1007-9327office wjg@wjgnet.com doi:10.3748/wjg.v18.i18.2219 World J Gastroenterol 2012 May 14; 18(18): 2219-2224 ISSN 1007-9327 (print) ISSN 2219-2840 (online)
More informationThe New England Journal of Medicine
The New England Journal of Medicine Copyright, 2000, by the Massachusetts Medical Society VOLUME 343 A UGUST 3, 2000 NUMBER EFFECT OF INTRAVENOUS OMEPRAZOLE ON RECURRENT BLEEDING AFTER ENDOSCOPIC TREATMENT
More informationSpectrum of upper gastrointestinal bleed in patients with cirrhosis of liver
Journal of College of Medical Sciences-Nepal, Vol-13, No 3, July-Sept 017 ISSN: 2091-0657 (Print); 2091-0673 (Online) Open Access Spectrum of upper gastrointestinal bleed in patients with cirrhosis of
More informationThe late prognosis of perforated duodenal ulcer
Gut, 1962, 3, 6 The late prognosis of perforated duodenal ulcer A. C. B. DEAN,1 C. G. CLARK, AND A. H. SINCLAIR-GIEBEN From Aberdeen Royal Infirmary and the Department of Mental Health, niversity of Aberdeen
More informationEmergency Operations for Bleeding Duodenal Ulcer:A simple option to consider Case Report Abstract Key words Case Report
Vtáx exñéüà :A simple option to consider: Case Report Gamal E H A El Shallaly, Eltayeb A Ali, Suzan Salih Abstract We report a 46 years-old man who had severe bleeding from a posterior duodenal ulcer (DU)
More informationACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis
ACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis Guadalupe Garcia-Tsao, M.D., 1 Arun J. Sanyal, M.D., 2 Norman D. Grace,
More informationTherapeutic Endoscopy for Nonvariceal Gastrointestinal Bleeding
Journal of Pediatric Gastroenterology and Nutrition 45:157 171 # 2007 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
More information