RESUMO
In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer.
Assuntos
Técnicas Hemostáticas , Úlcera Péptica Hemorrágica/terapia , Anti-Inflamatórios não Esteroides/efeitos adversos , Antiulcerosos/uso terapêutico , Anticoagulantes/efeitos adversos , Biomarcadores/sangue , Terapia Combinada , Comorbidade , Contraindicações de Medicamentos , Soluções Cristaloides , Gerenciamento Clínico , Endoscopia Gastrointestinal , Transfusão de Eritrócitos , Eritromicina/uso terapêutico , Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Humanos , Hipotensão/etiologia , Hipotensão/terapia , Intubação Gastrointestinal , Soluções Isotônicas/uso terapêutico , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Úlcera Péptica Hemorrágica/sangue , Úlcera Péptica Hemorrágica/etiologia , Exame Físico , Recidiva , Fatores de Risco , Vitamina K/uso terapêuticoRESUMO
BACKGROUND: Therapy of gastric varices (GV) is still challenging. Cyanoacrylate (CYA) injection is the recommended treatment for bleeding GV, but has a known adverse event rate, which could be reduced if EUS is used for guidance. Otherwise, EUS-guided coil application (ECA) may be an alternative. OBJECTIVES: To compare CYA and ECA embolization of feeding GV for feasibility, safety, and applicability. DESIGN: Retrospective analysis of a prospectively maintained database. SETTING: Multicenter study, tertiary referral centers. PATIENTS AND INTERVENTIONS: Thirty consecutive patients with localized GV who received either CYA injection or ECA were included with follow-up for 6 months after treatment. RESULTS: There were 11 patients in the coil group and 19 patients in the CYA group. The GV obliteration rate was 94.7% CYA versus 90.9% ECA; mean number of endoscopy sessions was 1.4 ± 0.1 (range 1-3). Adverse events occurred in 12 of 30 patients (40%) (CYA, 11/19 [57.9%]; ECA, 1/11 [9.1%]; P < .01); only 3 were symptomatic, and an additional 9 (CYA group) had glue embolism on a CT scan but was asymptomatic. No further adverse events occurred during follow-up. Six patients (20%) died unrelated to the procedures or bleeding. LIMITATIONS: Nonrandomized; EUS expertise necessary. CONCLUSIONS: EUS-guided therapy for GV by using CYA or ECA is effective in localized GV. ECA required fewer endoscopies and tended to have fewer adverse events compared with CYA injection. Larger comparative studies are needed to prove these data.
Assuntos
Cianoacrilatos/uso terapêutico , Embolização Terapêutica/métodos , Endossonografia/métodos , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Ultrassonografia de Intervenção/métodos , Idoso , Estudos de Coortes , Embolização Terapêutica/instrumentação , Varizes Esofágicas e Gástricas/complicações , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
UNLABELLED: The continuing care unit and day hospital allows ambulatory care of patients with digestive diseases. AIM: Reducing hospital admissions and the number of patients with digestive diseases that attend the emergency department. MATERIAL AND METHODS: Two types of care are provided: a) continuing care; patients are urgently visited when they show acute decompensation of their digestive disease, and b) scheduled care: procedures that, due to their complexity, require nursing care but not necessarily hospital admission. RESULTS: In the period 1995-2005, visits to the continuing care unit increased from 118 in 1995 to 784 in 2005. In scheduled care, the number of paracentesis increased from 237 in 1995 to 687 in 2006. Intravenous iron infusions increased from 111 in 2004 to 519 in 2006. The number of hospital admissions initially decreased from 605 in 1995 to 430 in 2000, and then increased. The number of patients with digestive diseases attending the emergency department decreased by 75% throughout the period studied. CONCLUSIONS: The continuing care unit and day hospital allowed an initial reduction in the number of conventional hospitalizations and in the percentage of patients with digestive diseases attending the emergency department.