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1.
Am J Surg ; 215(4): 603-609, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28629608

RESUMO

BACKGROUND: To evaluate roles of intraoperative endoscopy (IOE) in management of severe obscure GI bleeding (OGIB) before vs. after introduction of video capsule endoscopy (VCE) and deep enteroscopy (DE). METHODS: We retrospectively reviewed prospectively collected data of patients undergoing IOE for severe OGIB in a tertiary referral center. RESULTS: 52 patients had laparotomy/IOE for OGIB, 11 pre and 41 post VCE/DE eras. In the pre VCE/DE era, 36.4% (4/11) had preoperative presumptive diagnoses while in the post VCE/DE era presumptive diagnoses were made in 48.8% (20/41) (p = 0.18). Preoperative evaluation led to correct diagnoses in 18.2% (2/11) in the pre and 51.2% (21/41) in the post VCE/DE era (p = 0.09). Vascular lesions and ulcers were the most common diagnoses, but rebleeding was common. No rebleeding was found among patients with tumors, Meckel's diverticulum, and aortoenteric fistula. CONCLUSIONS: Presumptive diagnoses in the post VCE/DE era were usually accurate. If VCE or DE are negative, the probability of negative IOE is high. Patients with tumors and Meckel's diverticulum were the best candidates for IOE.


Assuntos
Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/métodos , Cuidados Intraoperatórios/métodos , Endoscopia por Cápsula , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
2.
Gastroenterology ; 152(6): 1310-1318.e1, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28167214

RESUMO

BACKGROUND & AIMS: For 4 decades, stigmata of recent hemorrhage in patients with nonvariceal lesions have been used for risk stratification and endoscopic hemostasis. The arterial blood flow that underlies the stigmata rarely is monitored, but can be used to determine risk for rebleeding. We performed a randomized controlled trial to determine whether Doppler endoscopic probe monitoring of blood flow improves risk stratification and outcomes in patients with severe nonvariceal upper gastrointestinal hemorrhage. METHODS: In a single-blind study performed at 2 referral centers we assigned 148 patients with severe nonvariceal upper gastrointestinal bleeding (125 with ulcers, 19 with Dieulafoy's lesions, and 4 with Mallory Weiss tears) to groups that underwent standard, visually guided endoscopic hemostasis (control, n = 76), or endoscopic hemostasis assisted by Doppler monitoring of blood flow under the stigmata (n = 72). The primary outcome was the rate of rebleeding after 30 days; secondary outcomes were complications, death, and need for transfusions, surgery, or angiography. RESULTS: There was a significant difference in the rates of lesion rebleeding within 30 days of endoscopic hemostasis in the control group (26.3%) vs the Doppler group (11.1%) (P = .0214). The odds ratio for rebleeding with Doppler monitoring was 0.35 (95% confidence interval, 0.143-0.8565) and the number needed to treat was 7. CONCLUSIONS: In a randomized controlled trial of patients with severe upper gastrointestinal hemorrhage from ulcers or other lesions, Doppler probe guided endoscopic hemostasis significantly reduced 30-day rates of rebleeding compared with standard, visually guided hemostasis. Guidelines for nonvariceal gastrointestinal bleeding should incorporate these results. ClinicalTrials.gov no: NCT00732212 (CLIN-013-07F).


Assuntos
Endossonografia , Hemostase Endoscópica/métodos , Síndrome de Mallory-Weiss/terapia , Úlcera Péptica Hemorrágica/terapia , Ultrassonografia Doppler , Malformações Vasculares/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Síndrome de Mallory-Weiss/diagnóstico por imagem , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/diagnóstico por imagem , Recidiva , Fluxo Sanguíneo Regional , Medição de Risco/métodos , Índice de Gravidade de Doença , Método Simples-Cego , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem
3.
Dig Dis Sci ; 61(9): 2732-40, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27286877

RESUMO

BACKGROUND: The sites of origin, causes and outcomes of severe hematochezia have not been compared between cirrhotics and non-cirrhotics. In cirrhotics versus non-cirrhotics presenting with severe hematochezia, we aimed at (1) identifying the site and etiology of gastro-intestinal bleeding and independent predictors of bleeding from the upper gastrointestinal tract versus small bowel or the colon, (2) comparing 30-day clinical outcomes, and (3) proposing an algorithm for management of severe hematochezia. METHODS: In this cohort study from two university-based medical centers, 860 consecutive patients with severe hematochezia admitted from 1995 to 2011 were prospectively enrolled with 160 (18.6 %) cirrhotics. We studied (a) general clinical and laboratory characteristics of cirrhotics versus non-cirrhotics, (b) predictors of bleeding sites in each patient group by multiple variable regression analysis, and compared (c) 30-day outcomes, including rebleeding, surgery and deaths. RESULTS: Cirrhosis independently predicted an upper gastrointestinal source of bleeding (OR 3.47; 95 % CI 2.01-5.96) as well as history of hematemesis, melena in the past 30 days, positive nasogastric aspirate, prior upper gastrointestinal bleeding or use of aspirin or non-steroidal anti-inflammatory. The most prevalent diagnoses were esophageal varices (20 %) in cirrhotics and colon diverticular bleeding (27.1 %) in non-cirrhotics. Thirty-day rates of rebleeding, surgical interventions and deaths were 23.1 versus 15 % (P = 0.01), 14.4 versus 6.4 % (P < 0.001), and 17.5 versus 4.1 % (P < 0.001), in cirrhotics versus non-cirrhotics, respectively. CONCLUSIONS: Cirrhosis predicted an upper gastrointestinal site of bleeding in patients presenting with severe hematochezia. The 30-day rates of rebleeding, surgery, and death were significantly higher in cirrhotics than in non-cirrhotics.


Assuntos
Doenças do Colo/epidemiologia , Doenças do Esôfago/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Cirrose Hepática/epidemiologia , Úlcera Péptica Hemorrágica/epidemiologia , Gastropatias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Angiodisplasia/complicações , Aspirina/uso terapêutico , Transfusão de Componentes Sanguíneos , California/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Colite Isquêmica/complicações , Doenças do Colo/etiologia , Doenças do Colo/terapia , Diverticulite/complicações , Transfusão de Eritrócitos , Doenças do Esôfago/etiologia , Doenças do Esôfago/terapia , Varizes Esofágicas e Gástricas/complicações , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hematemese/epidemiologia , Hematócrito , Hemorroidas/complicações , Humanos , Intestino Delgado , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Tempo de Tromboplastina Parcial , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/terapia , Plasma , Inibidores da Agregação Plaquetária/uso terapêutico , Contagem de Plaquetas , Transfusão de Plaquetas , Estudos Retrospectivos , Fatores de Risco , Gastropatias/terapia , Úlcera/complicações
4.
Gastrointest Endosc ; 83(2): 416-23, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26227931

RESUMO

BACKGROUND AND AIMS: Few prospective reports describe the short-term natural history of colon diverticular hemorrhage based on stigmata of recent hemorrhage, and none include blood flow detection for risk stratification or as a guide to definitive hemostasis. Our purposes were to report the 30-day natural history of definitive diverticular hemorrhage based on stigmata and to describe Doppler probe blood flow detection as a guide to definitive hemostasis. METHODS: Different cohorts of patients with severe diverticular bleeding and stigmata on urgent colonoscopy are reported. For 30-day natural history, patients were treated medically. If severe rebleeding occurred, they had surgical or angiographic treatment. We report natural history with major stigmata (active bleeding, visible vessel, or adherent clot) and no stigmata or flat spots after clots were washed away. We also report Doppler probe detection of arterial blood flow underneath stigmata before and after hemostasis in a recent cohort. RESULTS: For natural history, patients with major stigmata treated medically had 65.8% (25/38) rebleeding rates, and 44.7% (17/38) had intervention for hemostasis. Patients with spots or clean bases had no rebleeding. A Doppler probe detected arterial blood flow in 92% of major stigmata--none after hemostasis--and there was no rebleeding. CONCLUSIONS: (1) Patients with major stigmata treated medically had high rates of rebleeding and intervention for hemostasis. (2) Patients with clean diverticula or only flat spots had no rebleeding. (3) High rates of arterial blood flow were detected under major stigmata with a Doppler probe, but with obliteration by hemostasis no rebleeding occurred.


Assuntos
Colonoscopia/métodos , Divertículo do Colo/complicações , Endossonografia/métodos , Hemorragia Gastrointestinal/etiologia , Monitorização Fisiológica/métodos , Fluxo Sanguíneo Regional/fisiologia , Ultrassonografia Doppler em Cores/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Divertículo do Colo/diagnóstico por imagem , Divertículo do Colo/fisiopatologia , Feminino , Seguimentos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva
5.
Gastrointest Endosc ; 83(1): 129-36, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26318834

RESUMO

BACKGROUND AND AIMS: For more than 4 decades endoscopists have relied on ulcer stigmata for risk stratification and as a guide to hemostasis. None used arterial blood flow underneath stigmata to predict outcomes. For patients with severe peptic ulcer bleeding (PUB), we used a Doppler endoscopic probe (DEP) for (1) detection of blood flow underlying stigmata of recent hemorrhage (SRH), (2) quantitating rates of residual arterial blood flow under SRH after visually directed standard endoscopic treatment, and (3) comparing risks of rebleeding and actual 30-day rebleed rates for spurting arterial bleeding (Forrest [F] IA) and oozing bleeding (F IB). METHODS: Prospective cohort study of 163 consecutive patients with severe PUB and different SRH. RESULTS: All blood flow detected by the DEP was arterial. Detection rates were 87.4% in major SRH-spurting arterial bleeding (F IA), non-bleeding visible vessel (F IIA), clot (F IIB)-and were significantly lower at 42.3% (P < .0001) for an intermediate group of oozing bleeding (F IB) or flat spot (F IIC). For spurting bleeding (F IA) versus oozing (F IB), baseline DEP arterial flow was 100% versus 46.7%, residual blood flow detected after endoscopic hemostasis was 35.7% versus 0%, and 30-day rebleed rates were 28.6% versus 0% (all P < .05). CONCLUSIONS: (1) For major SRH versus oozing or spot, the arterial blood flow detection rate by the DEP was significantly higher, indicating a higher rebleed risk. (2) Before and after endoscopic treatment, spurting (F IA) PUB had significantly higher rates of blood flow detection than oozing (F IB) PUB and a significantly higher 30-day rebleed rate. (3) The DEP is recommended as a new endoscopic guide with SRH to improve risk stratification and potentially definitive hemostasis for PUB.


Assuntos
Úlcera Duodenal/diagnóstico , Duodeno/irrigação sanguínea , Fluxometria por Laser-Doppler/métodos , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Gástrica/diagnóstico , Estômago/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Úlcera Duodenal/cirurgia , Endoscopia do Sistema Digestório/métodos , Feminino , Hemostase Endoscópica/métodos , Humanos , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/cirurgia , Estudos Prospectivos , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Úlcera Gástrica/cirurgia
6.
J Clin Gastroenterol ; 50(1): 52-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25599218

RESUMO

BACKGROUND AND AIMS: Improved medical decisions by using a score at the initial patient triage level may lead to improvements in patient management, outcomes, and resource utilization. There is no validated score for management of lower gastrointestinal bleeding (LGIB) unlike for upper gastrointestinal bleeding. The aim of our study was to compare the accuracies of 3 different prognostic scores [Center for Ulcer Research and Education Hemostasis prognosis score, Charlson index, and American Society of Anesthesiologists (ASA) score] for the prediction of 30-day rebleeding, surgery, and death in severe LGIB. METHODS: Data on consecutive patients hospitalized with severe gastrointestinal bleeding from January 2006 to October 2011 in our 2 tertiary academic referral centers were prospectively collected. Sensitivities, specificities, accuracies, and area under the receiver operator characteristic curve were computed for 3 scores for predictions of rebleeding, surgery, and mortality at 30 days. RESULTS: Two hundred thirty-five consecutive patients with LGIB were included between 2006 and 2011. Twenty-three percent of patients rebled, 6% had surgery, and 7.7% of patients died. The accuracies of each score never reached 70% for predicting rebleeding or surgery in either. The ASA score had a highest accuracy for predicting mortality within 30 days (83.5%), whereas the Center for Ulcer Research and Education Hemostasis prognosis score and the Charlson index both had accuracies <75% for the prediction of death within 30 days. CONCLUSIONS: ASA score could be useful to predict death within 30 days. However, a new score is still warranted to predict all 30 days outcomes (rebleeding, surgery, and death) in LGIB.


Assuntos
Hemorragia Gastrointestinal/terapia , Hospitalização , Avaliação de Resultados da Assistência ao Paciente , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemorragia Gastrointestinal/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Centros de Atenção Terciária , Resultado do Tratamento
7.
World J Gastroenterol ; 20(38): 13993-8, 2014 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-25320538

RESUMO

AIM: To describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH). METHODS: This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011. RESULTS: A total of 1249 patients were registered for severe UGIH in the data basis, 461 (36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen (75%) subjects required posterior nasal packing and 2 (10%) embolization in addition to correction of coagulopathy. Five (25%) patients died in the hospital, 12 (60%) received orthotopic liver transplantation (OLT), and 3 (15%) were discharged without OLT. The mortality rate was 63% in patients without OLT. CONCLUSION: Severe epistaxis in patients with ESLD is (1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH; and (2) associated with a high mortality rate in patients not receiving OLT.


Assuntos
Doença Hepática Terminal/complicações , Epistaxe/etiologia , Hemorragia Gastrointestinal/etiologia , Adulto , Idoso , California/epidemiologia , Bases de Dados Factuais , Diagnóstico Diferencial , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/terapia , Epistaxe/diagnóstico , Epistaxe/mortalidade , Epistaxe/terapia , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Mortalidade Hospitalar , Humanos , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Valor Preditivo dos Testes , Prevalência , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
8.
Gastrointest Endosc ; 74(4): 852-7, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21839438

RESUMO

BACKGROUND: Risk factors and outcomes of severe hematochezia from ischemic colitis compared with other colonic diagnoses have not been well studied. OBJECTIVE: Our purposes were (1) to compare demographics and outcomes of patients hospitalized with severe hematochezia from ischemic colitis compared with other colonic diagnoses, (2) to compare inpatient and outpatient start of bleeding from ischemic colitis, and (3) to describe potential risk factors. DESIGN: Prospective cohort study. SETTING: Tertiary referral academic centers. PATIENTS: Patients referred for gastroenterology consultation for severe hematochezia. INTERVENTIONS: Colonoscopic therapy was provided as indicated. MAIN OUTCOME MEASUREMENTS: Rebleeding, surgery, and length of hospital stay after colonoscopy. RESULTS: Of 550 patients in the past 12 years with severe hematochezia from colonic sources, the cause in 65 patients (11.8%) was ischemia. Ischemic colitis was found more often in females, in patients taking anticoagulant agents, in patients with severe lung disease, those with higher creatinine levels, those with higher glucose levels, and those with more fresh frozen plasma transfusions. Five patients with focal lesions had colonoscopic hemostasis. Major 30-day outcomes of ischemic colitis patients were significantly worse than patients with other colonic diagnoses. Patients with inpatient (vs outpatient) ischemic colitis had significantly more and more severe comorbidities at baseline and significantly higher rates of rebleeding, surgery, and more days spent in hospital and in the intensive care unit. LIMITATIONS: Two-center study. CONCLUSIONS: Major 30-day outcomes in ischemic colitis patients were significantly worse than in patients with other colonic diagnoses. Comparing outpatient and inpatient start of ischemic colitis, inpatients had significantly worse outcomes.


Assuntos
Colite Isquêmica/complicações , Doenças do Colo/complicações , Hemorragia Gastrointestinal/etiologia , Colite Isquêmica/diagnóstico , Doenças do Colo/diagnóstico , Colonoscopia , Feminino , Hemorragia Gastrointestinal/cirurgia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Fatores de Risco
9.
Gastrointest Endosc ; 70(5): 969-75, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19640519

RESUMO

BACKGROUND: Several different hemoclips are marketed for endoscopic hemostasis of nonvariceal upper GI (UGI) bleeding. No previous reports have compared success rates of clip deployment onto bases of chronic gastric ulcers (GUs), clip retention rates, or their influence on ulcer healing. OBJECTIVES: For the treatment of chronic GUs, to compare 3 different hemoclips with multipolar electrocoagulation (MPEC) and control. DESIGN: Randomized, controlled study. SUBJECTS: Seven adult dogs with prehepatic portal hypertension had GUs created by rubber band ligation. Animals received oral proton pump inhibitors daily and underwent weekly endoscopies to quantitate clip retention and ulcer healing. INTERVENTIONS: One week after banding, 10 chronic ulcers were randomized in pairs to control (no endoscopic treatment), MPEC, or different hemoclips (QuickClip2 [QC], TriClip [TC], or Resolution Clip [RC]). MAIN OUTCOME MEASUREMENTS: Times and success of hemoclip deployment, clip retention rates, and ulcer healing rates on weekly endoscopies. RESULTS: Success rates of clip deployment were 100% for the RC, 93.1% for the TC, and 83.3% for the QC. Clip retention rates were significantly higher with the RC than the QC or TC at 1 to 3 weeks. Retained clips did not delay GU healing compared with MPEC or control. CONCLUSIONS: Hemoclipping time was similar with all 3 clips; the RC was retained significantly longer than the QC or TC, hemoclips did not delay ulcer healing compared with control or MPEC, and all 3 hemoclips were safe and no complications such as bleeding and weight loss were noted.


Assuntos
Hemostase Endoscópica/instrumentação , Úlcera Péptica Hemorrágica/cirurgia , Úlcera Gástrica/cirurgia , Animais , Doença Crônica , Modelos Animais de Doenças , Cães , Desenho de Equipamento , Seguimentos , Estudos Prospectivos , Resultado do Tratamento
10.
Rev Gastroenterol Disord ; 9(1): 16-26, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19367214

RESUMO

Hemorrhoids are common in Western societies. Appropriate assessment and treatment of symptomatic hemorrhoids can substantially reduce morbidity and improve patient well-being. In this article, the clinical presentation, differential diagnoses, and current treatment options, including the CRH-O'Regan banding device, an emerging technology for the anoscopic treatment of symptomatic internal hemorrhoids, are reviewed.


Assuntos
Hemorroidas/diagnóstico , Hemorroidas/terapia , Diagnóstico Diferencial , Eletrocoagulação/métodos , Endoscopia Gastrointestinal , Desenho de Equipamento , Hemorroidas/complicações , Humanos , Ligadura/instrumentação , Complicações Pós-Operatórias , Escleroterapia/métodos , Instrumentos Cirúrgicos
11.
Indian J Gastroenterol ; 25 Suppl 1: S43-51, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17151435

RESUMO

Severe hematochezia is a common reason for hospitalization but the causes have changed in the last decade. Changes are in part related to the aging population, the evaluation and treatment by colonoscopists rather than surgeons or non-endoscopists, and the changes in colonoscopic practices such as piecemeal polypectomy. A careful history, physical examination, rectal examination, and nasogastric lavage may help localize the bleeding site and focus the differential diagnosis. This should be routine while resuscitating the patient. However, purging the colon for urgent colonoscopy may be the most definitive way to combine diagnosis and treatment of bleeding colonic lesions. Complete colonoscopy with intubation of the terminal ileum is recommended, and also examination of the rectum with a slotted anoscope. If those examinations are negative, a push enteroscopy is recommended for combined diagnosis and treatment. With recent advances in colonoscopic hemostasis, patients will benefit from diagnosis and treatment by experienced colonoscopists. Also, urgent colonoscopy after purge has been reported to be more cost-effective than elective colonoscopy or other strategies for diagnosis of severe hematochezia.


Assuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico , Colite Isquêmica/epidemiologia , Colonoscopia , Comorbidade , Divertículo/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hemangioma/epidemiologia , Hemorroidas/epidemiologia , Humanos , Sigmoidoscopia
12.
Gastrointest Endosc ; 64(5): 768-73, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17055872

RESUMO

BACKGROUND: Mechanical closure of bleeding vessels is clinically appealing, and several types of hemoclips are now marketed for endoscopic hemostasis of nonvariceal lesions. No comparative data have been reported on ease of clip placement, hemostasis efficacy, or clip retention rates on bleeding ulcers. OBJECTIVE: To compare 3 different types of hemoclips for hemostasis of bleeding ulcers. DESIGN: Randomized controlled study. SUBJECTS: Seven adult dogs with prehepatic portal hypertension were heparinized, and acute gastric ulcers were made with jumbo biopsy forceps. Animals had oral proton pump inhibitors daily and weekly endoscopies to quantitate clip retention and ulcer healing. INTERVENTIONS: Bleeding ulcers were randomized in pairs (2 for each treatment/dog) to endoscopic hemoclip treatment or control. MAIN OUTCOME MEASUREMENTS: Initial times and success of deployment, hemostasis efficacy, clip retention rates, and ulcer healing during endoscopic follow-ups. RESULTS: There was no difference in initial hemostasis rates of hemoclips, and no major complications occurred. Ulcer healing times were faster (Resolution Clip [RC] or TriClip [TC]) or similar (QuickClip2 [QC]) to controls. Clip retention at 1 week was significantly less with TC and, at 3 to 7 weeks, was significantly higher with RC. CONCLUSIONS: (1) For the 3 hemoclip devices, initial hemostasis rates were 100%, but all devices required similar learning time to place clips successfully. (2) Short-term retention rates of TC were significantly less than QC or RC. (3) Long-term clip retention was significantly higher with RC. (4) All 3 hemoclips were safe, and none interfered with ulcer healing.


Assuntos
Hemostase Endoscópica/instrumentação , Úlcera Péptica Hemorrágica/cirurgia , Úlcera Péptica Hemorrágica/terapia , Úlcera Gástrica/cirurgia , Instrumentos Cirúrgicos , Doença Aguda , Animais , Modelos Animais de Doenças , Cães , Desenho de Equipamento , Hipertensão Portal/complicações , Distribuição Aleatória , Fatores de Tempo , Resultado do Tratamento , Cicatrização
14.
J Trauma ; 57(1 Suppl): S33-7, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15280749

RESUMO

BACKGROUND: The safety and efficacy of poly-N-acetyl glucosamine (p-GlcNAc) gels were compared with standard agents in three different dog studies to assess abdominal venous collaterals, bleeding esophageal varices, and bleeding gastric varices. METHODS: Adult dogs with prehepatic portal hypertension and large abdominal venous collaterals, esophageal varices, or gastric varices were studied. RESULTS: Significantly higher sclerosis rates were seen with F2 or F4 p-GlcNAc gels and standard sclerosants. F2 and F4 gels had high rates of permanent hemostasis, low rates of secondary ulceration, and significant reductions in esophageal and gastric variceal size. These results were either equivalent to or significantly better than the most commonly used gastric varix hemostatic agent (glue) or other sclerosing agents. CONCLUSION: F2 and F4 poly-N-acetyl glucosamine gels are promising therapeutic agents for venous and variceal hemostasis.


Assuntos
Acetilglucosamina/uso terapêutico , Modelos Animais de Doenças , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/tratamento farmacológico , Hemostáticos/uso terapêutico , Acetilglucosamina/química , Acetilglucosamina/farmacologia , Álcoois/uso terapêutico , Animais , Química Farmacêutica , Cães , Método Duplo-Cego , Avaliação Pré-Clínica de Medicamentos , Embucrilato/uso terapêutico , Esofagoscopia , Hemorragia Gastrointestinal/etiologia , Gastroscopia , Géis , Técnicas Hemostáticas/normas , Hemostáticos/química , Hemostáticos/farmacologia , Hipertensão Portal/complicações , Ácidos Oleicos/uso terapêutico , Distribuição Aleatória , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Escleroterapia/normas , Morruato de Sódio/uso terapêutico , Cicatrização/efeitos dos fármacos
15.
Gastrointest Endosc ; 57(4): 462-8, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12665754

RESUMO

BACKGROUND: Endoscopic diagnosis and treatment of hematochezia caused by rectal ulcers is poorly described. METHODS: Consecutive patients hospitalized with severe hematochezia underwent urgent colonoscopy after purge. Those with rectal ulcers were divided into 2 groups based on the absence or presence of major stigmata of recent hemorrhage: active bleeding, visible vessel, or adherent clot. Major stigmata were treated with epinephrine injection and coagulation with a bipolar probe. The primary outcome endpoint was recurrent bleeding within 4 weeks of diagnosis. RESULTS: Rectal ulcers were identified in 23 of 285 (8%) patients. Twelve of 23 patients had major stigmata; these patients had an arithmetically greater decrease in hematocrit and required more blood transfusions than patients without major stigmata. Initial hemostasis was achieved in all, but bleeding recurred in 5 with stigmata. Four patients died of comorbid conditions. There was no recurrent bleeding or death in those without stigmata. CONCLUSIONS: Patients with rectal ulcers harboring major stigmata are at high risk for severe bleeding, recurrent bleeding, and death. For ulcers with major stigmata, endoscopic hemostasis is feasible but rates of recurrent bleeding are high.


Assuntos
Colonoscopia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Doenças Retais/diagnóstico , Doenças Retais/terapia , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Prognóstico , Resultado do Tratamento , Úlcera
16.
Gastroenterology ; 123(2): 407-13, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12145792

RESUMO

BACKGROUND & AIMS: Treatment of high-risk patients with nonbleeding adherent clots on ulcers is controversial. In a previous randomized trial, there was no benefit to endoscopic therapies compared with medical therapy for prevention of ulcer rebleeding. Our purpose was to test the hypothesis that patients treated with combination endoscopic therapy would have significantly lower rebleeding rates than those treated with medical therapy. METHODS: In this randomized, controlled trial, 32 high-risk patients with severe ulcer hemorrhage and nonbleeding adherent clots resistant to target irrigation were randomized to medical therapy or to combination endoscopic therapy (with epinephrine injection, shaving down the clot with cold guillotining, and bipolar coagulation on the underlying stigmata). Physicians blinded to the endoscopic therapy managed all patients. RESULTS: Patients were similar at study entry, except for older age in the medical group and lower platelet count in the endoscopic group. By hospital discharge, significantly more medically treated patients (6/17; 35.3%) than endoscopically treated patients (0/15; 0%) rebled (P = 0.011). There were no complications of endoscopic treatment. CONCLUSIONS: Combination endoscopic therapy of nonbleeding adherent clots significantly reduced early ulcer rebleeding rates in high-risk patients compared with medical therapy alone. This endoscopic treatment was safe.


Assuntos
Úlcera Péptica Hemorrágica/prevenção & controle , Úlcera Péptica/terapia , Idoso , Coagulação Sanguínea , Endoscopia Gastrointestinal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva
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