Endoscopic hemostasis state of the art - Nonvaricealbleeding

• 作者: Helmut Messmann Juliane Brueckner Stefan Karl Goelder
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: GASTROINTESTINAL BLEEDING Endoscopictreatment INTESTINAL HEMORRHAGE Endoscopic CLIPS TOPICAL hemostatic substances
• 年，卷（期）: 2016,（4）
• 页码范围: 205-211
• 页数: 7页
• 分类号: R

摘要

New endoscopic techniques for hemostasis in nonvaricealbleeding were introduced and known methodsfurther improved. Hemospray and Endoclot are twonew compounds for topical treatment of bleeding. Initialstudies in this area have shown a good hemostaticeffect, especially in active large scale oozing bleeding,e.g. , tumor bleedings. For further evaluation largerprospective studies comparing the substanced withother methods of endoscopic hemostasis are needed.For localized active arterial bleeding primary injectiontherapy in the area of bleeding as well as in the fouradjacent quadrants offers a good method to reducebleeding activity. The injection is technically easy tolearn and practicable. After bleeding activity is reducedthe bleeding source can be localized more clearly forclip application. Today many different through-thescope（TTS） clips are available. The ability to close andreopen a clip can aid towards good positioning at thebleeding site. Even more important is the rotatability ofa clip before application. Often multiple TTS clips arerequired for secure closure of a bleeding vessel. Onemodel has the ability to use three clips in series withoutchanging the applicator. Severe arterial bleeding fromvessels larger than 2 mm is often unmanageable withthese conventional methods. Here is the over-the-scopeclipsystem another newly available method. It is similarto the ligation of esophageal varices and involves aspirationof tissue into a transparent cap before closureof the clip. Thus a greater vascular occlusion pressurecan be achieved and larger vessels can be treatedendoscopically. Patients with severe arterial bleedingfrom the upper gastrointestinal tract have a very highrate of recurrence after initial endoscopic treatment.These patients should always be managed in aninterdisciplinary team of interventional radiologist andsurgeons.