Üst Gastrointestinal Sistem Kanamalarında Erken Endoskopinin Mortalite ve Morbiditeye Etkisi

Abstract

Üst gastrointestinal sistem (ÜGİS) kanamaları özofagusun üst kısmı ile Treitz ligamanı arasındaki herhangi bir yerden lümen içine olan kanamaları kapsar. ÜGİS kanaması olan hasta acil servise hematemez, melena veya hematokezya ile başvurabilir. Akut ÜGİS kanamalı hastalara ilk 24 saat içinde endoskopi uygulamak standart yaklaşımdır. Bununla birlikte erken endoskopinin tanımı konusunda ortak bir görüş yoktur. Çeşitli çalışmalara göre bu tanım acil servise başvurudan sonra 2 saat ile 24 saat arasında çeşitlilik gösterir. Bizim çalışmamızda ÜGİS kanaması ile acil servise başvuran 115 hasta alındı. Hastalar endoskopi yapılma sürelerine göre 3 gruba ayrıldığında (<8 saat, 8- 24 saat, >24 saat) gruplar arasında endoskopik bulgu, Forrest sınıflandırması, endoskopik veya cerrahi tedavi ihtiyacı, replasman ihtiyacı, takiplerde tekrarlayan kanama, tekrarlayan endoskopi ihtiyacı ve hastaların akıbeti konusunda anlamlı fark saptanmadı. Sonuç olarak ÜGİS kanamalarında erken endoskopinin tanımı, ilk 24 saat içinde ne zaman yapılacağı ve faydaları konusunda ortak bir görüş yoktur, yapılan prospektif randomize çalışmalar da erken endoskopinin kar zarar oranını belirlemede göz önünde bulundurulmalıdır.

Keywords

• üst gastrointestinal sistem kanamaları
• üst gastrointestinal sistem kanamalı hastaya yaklaşım
• erken endoskopi.

Effect of Early Endoscopy on Mortality and Morbidity in Upper Gastrointestinal System Bleeding

Abstract

Upper gastrointestinal (UGI) bleeding includes bleeding into the lumen from anywhere between the upper part of the esophagus and the ligament of Treitz. A patient with UGI bleeding may present to the emergency department with hematemesis, melena, or hematochezia. It is the standard approach to perform endoscopy within the first 24 hours in patients with acute UGI bleeding. However, there is no common opinion on the definition of early endoscopy. According to various studies, this definition varies between 2 hours and 24 hours after admission to the emergency department. In our study, 115 patients who applied to the emergency department with UGI bleeding were included. When the patients are divided into 3 groups according to the duration of endoscopy (<8 hours, 8-24 hours, >24 hours), there are differences between the groups regarding endoscopic findings, Forrest classification, need for endoscopic or surgical treatment, need for replacement, recurrent bleeding during follow-up, need for repeat endoscopy and the outcome of the patients. No significant difference was detected. As a result, there is no common opinion on the definition of early endoscopy in UGI bleeding, when it should be performed within the first 24 hours, and its benefits. Prospective randomized studies should also be taken into consideration in determining the benefit and harm ratio of early endoscopy.

Keywords

• upper gastrointestinal tract bleeding
• approach to the patient with upper gastrointestinal tract bleeding
• early endoscopy.

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