Peptic ulcer disease endoscopy
Endoscopic therapy
Endoscopic therapy can be done by following methods:[1]
- Injection therapy: Injection of diluted epinephrine (1:10,000) is commonly used[2]
- Thermal coagulationd: injection of sclerosan
- Contact types -heater probe, monopolar and bipolar electrocoagulation
- Noncontact types -laser treatment, argon plasma coagulation [APC][3]
- Mechanical Devices-Endooclips are used commonly[4][5]
- Combined Therapy-injection of diluted epinephrine followed by thermal coagulation[3]
Indications for endoscopic therapy
- Patients with active spurting or oozing bleeding or a non-bleeding visible vessel[6]
| Active bleeding or non bleeding visible vessel | |||||||||||||||||||
| Endoscopic therapy | |||||||||||||||||||
| IV PPI bolus +infections | |||||||||||||||||||
- Patients with an adherent clot resistant to vigorous irrigation
| Adherent clot | |||||||||||||||||||
| Endoscopic therapy | |||||||||||||||||||
| IV PPI bolus +infections | |||||||||||||||||||
References
- ↑ Cook DJ, Guyatt GH, Salena BJ, Laine LA (1992). "Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis". Gastroenterology. 102 (1): 139–48. PMID 1530782.
- ↑ Park CH, Lee SJ, Park JH, Park JH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ (2004). "Optimal injection volume of epinephrine for endoscopic prevention of recurrent peptic ulcer bleeding". Gastrointest. Endosc. 60 (6): 875–80. PMID 15605000.
- ↑ 3.0 3.1 Lin HJ, Tseng GY, Perng CL, Lee FY, Chang FY, Lee SD (1999). "Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding". Gut. 44 (5): 715–9. PMC 1727515. PMID 10205211.
- ↑ Ohta S, Yukioka T, Ohta S, Miyagatani Y, Matsuda H, Shimazaki S (1996). "Hemostasis with endoscopic hemoclipping for severe gastrointestinal bleeding in critically ill patients". Am. J. Gastroenterol. 91 (4): 701–4. PMID 8677932.
- ↑ Scapa E (1997). "Treating gastrointestinal bleeding with endoscopic hemoclips". Surg Laparosc Endosc. 7 (2): 94–6. PMID 9109234.
- ↑ Laine L, McQuaid KR (2009). "Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials". Clin. Gastroenterol. Hepatol. 7 (1): 33–47, quiz 1–2. doi:10.1016/j.cgh.2008.08.016. PMID 18986845.