Peptic ulcer disease endoscopy
Endoscopic therapy
Indications for endoscopic therapy
- Patients with active spurting or oozing bleeding or a non-bleeding visible vessel[1]
- Patients with an adherent clot resistant to vigorous irrigation
Endoscopic therapy can be done by following methods:[2]
- Injection therapy:
- Thermal coagulation:
- Contact types -heater probe, monopolar and bipolar electrocoagulation
- Noncontact types -laser treatment, argon plasma coagulation [APC][7]
- Mechanical Devices-Endooclips and band ligation are used commonly[8][9]
- Combined Therapy-injection of diluted epinephrine followed by thermal coagulation[7]
- Hemospray: nanopowder with clotting abilities is sprayed onto the bleeding site.[10]
Endoscopic therapy and Medical therapy for bleeding ulcer
| Active bleeding or non bleeding visible vessel | |||||||||||||||||||
| Endoscopic therapy | |||||||||||||||||||
| IV PPI bolus +infusions | |||||||||||||||||||
| Adherent clot | |||||||||||||||||||
| Endoscopic therapy | |||||||||||||||||||
| IV PPI bolus +infusions | |||||||||||||||||||
Second look endoscopy
- Second look endoscopy is used to detect and retreat ulcers that are at risk of recurrent bleeding which reduces the number of episodes of recurrent bleeding and hence decrease the surgery necessary to treat recurrent bleeding[11][12]
- It is usually done after 24 hours.
If bleeding occurs after a second endoscopic therapeutic session, surgery or interventional radiology with transcatheter arterial embolization is done.
References
- ↑ 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.
- ↑ 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.
- ↑ Rutgeerts P, Rauws E, Wara P, Swain P, Hoos A, Solleder E, Halttunen J, Dobrilla G, Richter G, Prassler R (1997). "Randomised trial of single and repeated fibrin glue compared with injection of polidocanol in treatment of bleeding peptic ulcer". Lancet. 350 (9079): 692–6. PMID 9291903.
- ↑ Chung SC, Leong HT, Chan AC, Lau JY, Yung MY, Leung JW, Li AK (1996). "Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial". Gastrointest. Endosc. 43 (6): 591–5. PMID 8781939.
- ↑ Scharnke W, Hust MH, Braun B, Schumm W (1997). "[Complete gastric wall necrosis after endoscopic sclerotherapy for a gastric ulcer with visible arterial stump]". Dtsch. Med. Wochenschr. (in German). 122 (19): 606–9. doi:10.1055/s-2008-1047662. PMID 9182025.
- ↑ 7.0 7.1 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.
- ↑ Sung JJ, Luo D, Wu JC, Ching JY, Chan FK, Lau JY, Mack S, Ducharme R, Okolo P, Canto M, Kalloo A, Giday SA (2011). "Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding". Endoscopy. 43 (4): 291–5. doi:10.1055/s-0030-1256311. PMID 21455870.
- ↑ Chiu PW, Lam CY, Lee SW, Kwong KH, Lam SH, Lee DT, Kwok SP (2003). "Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial". Gut. 52 (10): 1403–7. PMC 1773815. PMID 12970130.
- ↑ Villanueva C, Balanzó J, Torras X, Soriano G, Sáinz S, Vilardell F (1994). "Value of second-look endoscopy after injection therapy for bleeding peptic ulcer: a prospective and randomized trial". Gastrointest. Endosc. 40 (1): 34–9. PMID 8163132.