Endoscopic clipping for non-variceal upper gastrointestinal bleeding

Yıl 2014, Cilt: 13 Sayı: 1, 13 - 17, 01.04.2014

Hüseyin Köseoğlu Fatma Ebru Akın Aylin Demirezer Bolat Tevfik Solakoğlu - Roni Atalay Sevil Özer Sarı Eyüp Selvi Öykü Tayfur Yürekli Naciye Şemnur Büyükaşık Osman Ersoy -

Öz

Background and Aims: Endoscopic clipping has been widely used for upper gastrointestinal bleeding. It has been shown that hemostasis with endoscopic clipping is successful in bleeding peptic ulcers, Dieulafoy's lesions, and Mallory-Weiss tears. The aim of this study was to evaluate the efficacy of endoscopic clipping in our endoscopy unit. Materials and Methods: Patients presenting with upper gastrointestinal bleeding were evaluated retrospectively. Twenty-seven patients were treated with endoscopic clipping. The etiology of bleeding, rebleeding rates, need for packed red blood cell transfusion, mortality rate, and the Rockall and Glasgow-Blatchford scores were noted. Results:The mean age of the patients (17 male, 10 female) was 58,7 years. Five patients had gastric ulcer (1 Forrest 1a, 2 Forrest 1b, 2 Forrest 2a), 10 patients duodenal ulcer (5 Forrest 1b, 5 Forrest 2a), 7 patients MalloryWeiss tears, and 4 patients Dieulafoy's lesion as the etiology of upper gastrointestinal bleeding. One patient had Forrest 2a duodenal ulcer and Mallory-Weiss tears. Two of the patients (7,4%) rebled. Nineteen patients needed packed red blood cell transfusion with a total of 72 units. The mean Rockall score was 2,9 and the mean Glasgow-Blatchford score was 8,5. Conclusions:Although our patient population was high-risk, the rebleeding rate was low, and none of the patients died.

Anahtar Kelimeler

Endoscopic clipping, non-variceal upper gastrointestinal bleeding, peptic ulcer, Dieulafoy's lesion, Mallory-Weiss tears. Adres: Hüseyin KÖSEOĞLU Yıldırım Beyazıt Üniversitesi Sağlık Uygulama ve Araştırma Merkezi (Atatürk Eğitim ve Ara

Varis dışı üst GİS kanamalı hastalarda endoskopik klip uygulamalarımız

Öz

Giriş ve Amaç: Endoskopik klip uygulaması üst gastrointestinal sistem kanaması tedavisinde yaygın olarak kullanılmaktadır. Kanayan peptik ülser, Dieulafoy lezyonu ve Mallory-Weiss yırtığında klip ile kanama kontrolünün sağlanabileceği gösterilmiştir. Biz bu çalışmada kliniğimizin üst gastrointestinal sistem kanamasında endoskopik klip uygulama verilerini değerlendirdik. Gereç ve Yöntem:Üst gastrointestinal sistem kanaması nedeniyle yatırılan ve endoskopik klip uygulanan 27 hasta retrospektif olarak incelendi. Klip uygulama nedenleri, tekrar kanama sıklığı, eritrosit süspansiyon ihtiyaçları, mortalite sıklığı, Rockall skoru ve Glasgow-Blatchford skoru değerlendirildi. Bulgular:Çalışmaya dahil edilen hastaların 17'si erkek, 10'u kadın idi ve yaş ortalaması 58,7 yıl olarak hesaplandı. Klip uygulanan 5 hastada gastrik ülser (1 hasta Forrest 1a, 2 hasta Forrest 1b, 2 hasta Forrest 2a); 10 hastada duodenal ülser (5 hasta Forrest 1b, 5 hasta Forrest 2a); 7 hastada Mallory-Weiss yırtığı ve 4 hastada Dieulafoy lezyonu üst gastrointestinal sistem kanamasının nedeni idi. Hastalardan birinde ise hem Forrest 2a duodenum ülseri hem de Mallory-Weiss yırtığı mevcuttu. 27 hastanın 2'sinde (%7,4) işlem sonrası takip sırasında kanama tekrarladı. Hastaların 19'unda (%70) eritrosit süspansyonu ihtiyacı oldu ve toplam 72 ünite ES verildi. Hastaların ortalama Rockall skoru 2,9 ve ortalama Glasgow-Blatchford skoru 8,5 idi. Sonuç: Prognoz açısından riskli olan hastalarımızda mortalite saptanmamış ve tekrar kanama riski düşük bulunmuştur.

Anahtar Kelimeler

Endoskopik klip, varis dışı üst gastrointestinal kanama, peptik ülser, Dieulafoy lezyonu, Mallory-Weiss yırtığı

Kaynakça

• Sung JJ, Tsoi KK, Lai LH, et al. Endoscopic clipping versus injec- tion and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut 2007; 56:1364-73.
• Yamaguchi Y, Yamato T, Katsumi N, et al. Endoscopic hemoclip- ping for upper GI bleeding due to Mallory-Weiss syndrome. Gastro- intest Endosc 2001; 53:427-30.
• Chung IK, Kim EJ, Lee MS, et al. Bleeding Dieulafoy’s lesions and the choice of endoscopic method: comparing the hemostatic ef- ficacy of mechanical and injection methods. Gastrointest Endosc 2000; 52:721-4.
• Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointesti- nal bleeding. Lancet 1974; 2:394-7.
• Dy NM, Gostout CJ, Balm RK. Bleeding from the endoscopically- identified Dieulafoy lesion of the proximal small intestine and co- lon. Am J Gastroenterol 1995; 90:108-11.
• Rockall TA, Logan RF, Devlin HB, Northfield TC. Selection of pa- tients for early discharge or outpatient care after acute upper gas- trointestinal haemorrhage. National Audit of Acute Upper Gastro- intestinal Haemorrhage. Lancet 1996; 347:1138-40.
• Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000; 356:1318-21.
• Murphy MF, Wallington TB, Kelsey P, et al. British Committee for Standards in Haematology, Blood Transfusion Task Force. Guide- lines for the clinical use of red cell transfusions. Br J Haematol 2001; 113:24-31.
• Hayashi T, Yonezawa M, Kawabara T. The study on staunch clip for the treatment by endoscopy. Gastroenterol Endosc 1975;17:92- 101.
• Hokama A, Uehara T, Nakayoshi T, et al. Utility of endoscopic he- moclipping for colonic diverticular bleeding. Am J Gastroenterol 1997; 92:543-6.
• Parra-Blanco A, Kaminaga N, Kojima T, et al. Hemoclipping for postpolypectomy and postbiopsy colonic bleeding. Gastrointest Endosc 2000; 51:37-41.
• Tsunada S, Ogata S, Ohyama T, et al. Endoscopic closure of per- forations caused by EMR in the stomach by application of metallic clips. Gastrointest Endosc 2003; 57:948-51.
• Cipolletta L, Bianco MA, Marmo R, ve ark. Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointest Endosc 2001;53:147-51.
• Lin HJ, Hsieh YH, Tseng GY, et al. A prospective randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding. Am J Gastroenterol 2002; 97:2250-4.
• Yuan Y, Wang C, Hunt RH. Endoscopic clipping for acute nonvari- ceal upper-GI bleeding: a meta-analysis and critical appraisal of ran- domized controlled trials. Gastrointest Endosc 2008; 68:339-51.
• Huang SP, Wang HP, Lee YC, et al. Endoscopic hemoclip placement and epinephrine injection for Mallory-Weiss syndrome with active bleeding. Gastrointest Endosc 2002; 55:842-6.
• Park CH, Sohn YH, Lee WS, et al. The usefulness of endoscopic hemoclipping for bleeding Dieulafoy lesions. Endoscopy 2003: 35:388-92.