Çocuklarda Üst Gastrointestinal Sistem Kanamalarına Tanısal ve Tedavi Edici Endoskopik Yaklaşımlar

Öz

Gi rifl: Çocuklarda üst gastrointestinal sistem GİS kanamaları her zaman ileri araştırmayıgerektiren önemli bir sorundur. Bu çalışmanın amacı çocukluk çağında üst GİSkanamalarının nedenlerini ortaya çıkarmak ve bunlara yönelik terapötik endoskopikyaklaşımlar ile bunların tedavi edici etkinliklerini retrospektif olarak incelemektir. Gereç ve Yöntem: Pediatrik gastroenteroloji bölümlerimizce takip edilen üst GİSkanamalı 139 K/E:63/76 hasta yaş gruplarına, etyolojiye, kanamanın varislerden ve varisdışından olmasına, ilaç alım öyküsü olup olmamasına göre sınıflandırıldı. Ayrıca peptikülseri olan hastaların kanaması Forrest sınıflandırılmasına göre değerlendirildi.Çalışmada p0,68 . Sonuç: Endoskopinin çocukluk dönemi üst GİS kanamanın etyolojisinin aydınlatılmasında vekanamanın tedavisinde son derece yararlı olduğu düşünüldü

Anahtar Kelimeler

• Kanama,endoskopi,hemoklips

Diagnostic and Therapeutic Endoscopic Approaches to Upper Gastrointestinal System Bleeding in Children

Öz

In tro duc ti on: Upper gastrointestinal system bleeding in children is always very importantproblems requiring further investigation. The aim of the study was to investigateretrospectively the etiologies of upper gastrointestinal bleeding, the therapeuticendoscopic approach to the bleeding, and the efficacy of the endoscopy in the treatmentof pediatric age group. Materials and Methods: In this study, 139 F/M: 63/76 cases diagnosed as uppergastrointestinal bleeding and followed up by the Department of PediatricGastroenterology were classified into groups according to the age, etiology, thepresence of varicose veins, and history of drug ingestion. In addition bleedings causedby peptic ulcer disease were classified according to Forrest classification. Values ofp0.68 . Discussion: Endoscopic procedure is very useful in both the determination of etiology ofupper gastrointestinal bleeding and the treatment of upper gastrointestinal bleeding inchildhood

Anahtar Kelimeler

• Bleeding,endoscopy,hemoclips

Kaynakça

1. 1. Squires RH. Gastrointestinal Bleeding. Ped Rev 1999;20:95-101.
2. 2. Kasirga E. Gastrointestinal Bleeding ın Chilhood. Türkiye Klinikleri J Pediatr Sci 2005;1:21-31.
3. 3. Sarin N, Monga N, Adams PC. Time to endoscopy and out comes in upper gastrointestinal bleeding. Can J Gastroenterol 2009;23:489-93.
4. 4. Lacroix J, Nadeau D, Larberge S, Gauthier M, Lapierre G, Farrell CA. Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit. Crit Care Med 1992;20:35-42.
5. 5. Chaibau M, Tucci M, Dugas MA, Farell CA, Proulx F, Lacroix J. Clinically significant upper gastrointestinal bleeding acquired in a pediatric intensive care unit. A prospective study. Pediatric intensive care unit: A prospective study. Pediatrics 1998;102:933-8.
6. 6. Wyllie R, Kay M. Gastrointestinal hemorrhage. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointesitinal and Liver Disease. 3th ed. Philadelphia: Elsevier Inc; 2006:p.203-215.
7. 7. Peters JM. Management of Gastrointestinal Bleeding in Children. Curr Treat Options Gastroenterol 2002;5:399-413.
8. 8. Fox VL. Upper gastrointestinal bleeding. Int sem Pediatr Gastro Nutr 1999;8:1-9.

9. 9. Titchen T, Cranswick N, Beggs S. Adverse drug reactions to nonsteroidal anti-inflammatory drugs, CO-X2 inhibitors and paracetamol in a paediatric hospital. Br J Clin Pharmacol 2005;59:718-23.
10. 10. Kapetanos D, Beltsis A, Chatzimavroudis G, Katsinelos P. The use of endoclips in the treatment of nonvariceal gastrointestinal bleeding. Surg Laparosc Endosc Percutan Tech 2009;19:2-10.
11. 11. Grupka MJ, Benson J. Endoscopic clipping. J Dig Dis 2008;9:72-8.
12. 12. Lai YC, Yang SS, Wu CH, Chen TK. Endoscopic hemoclip treatment for bleeding peptic ulcer. World J Gastroenterol 2000;6:53-6.
13. 13. Kay M, Wyllie R. Esophagogastroduodenocopy, colonoscopy and related tecniques. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 3th ed. Philadelphia: Elsevier Inc;2006:p.1251-88.
14. 14. Mitsunaga T, Yoshida H, Kouchi K, Hishiki T, Saito T, Yamada S et al. Pediatric gastroesophagial varices: treatment strategy and long term results. J Pediatr Surg 2006;41;1980-3.
15. 15. Naga MI, Okasha HH, Foda AR, Gomaa MS, Fouad AM, Masoud AG et al. Detachable endoloop vs, elactic band ligation for bleeding esophageal varices. Gastrointestinal Endosc 2004;59;804-11.
16. 16. Mittal SK Kaira KK, Aggarwal V. Diagnostic upper GI endoscopy for hematemesis in children: experience from a pediatric gastroenterology centre in North India. Indian J Pediatr 1994;61:651-5.
17. 17. Yachia SK Khanduri A, Sharma BC, Kumar M. Gastrointestinal bleeding in children. K Gastroenterol Hepatol 1996;11:903-10.
18. 18. Poddar U, Phapa BR, Rao KL, Singh K. Etiological spectirum of esophagial varices due to portal hypertension in Indian children: Is it different from the West? J Gastroenterol Hepatol 2008;23:1354-61.
19. 19. Aydogdu S, Levent RE, Selimoglu MA, Yağcı RV. Upper gastrointestinal system bleeeding in children. Ege Tıp Dergisi 1999;38:9-12.
20. 20. Akcam M, Yılmaz A, Ertan R. Evaluation of children underwent endoscopy due toupper gastrointetinal bleeding: a retrospective analysis of 54 patients. SDU Tıp Fakültesi Dergisi 2006;13:22-30.
21. 21. Eren M, Hekim S. Upper gastrointestinal system bleeding in children: Etiology and treatment. Turkiye Klinikleri J Pediatr 2010;19:1-8.
22. 22. Woods KL, Smith JL, Graham DY. Intragastric accumulation of Evan’s blue as a method for asessing aspirin-induced acut gastric mucasal injury in humans. Dig Dis Sci 1988;33:769-73.
23. 23. Berezin SH, Bosttwick HE, Halata MS, Feerick J, Newman LJ, Medow MS. Gastrointestinal bleeding in children follwing ingestion of low dose ibuprofen. J Pediatr Gastroenterol Nutr 2007;44:506-8.
24. 24. Al Assi MT, genta RM, Karttunen TJ, Graham DY. Ulcer site and complications: relation to helicobacter pylori infection and NSAID use. Endoscopy 1996;28:229-33.
25. 25. Cooper GS, Chak A, Way LE, Hammar PJ, Harper DL, Rosenthal GE. Early endoscopy in upper gastrointestinal hemorrhage associatons with recurrent bleeding, surgery, and length of hospital stay. Gastrointest Endosc 1999;49:145-52.
26. 26. Naveau S, Bedossa P, Poynard T, Mory B, Chapot JC. Portal hypertansive colopaty. A new entity. Dig Dis Sci 1991;36:1774-81.
27. 27. Adler DG, Leighton JA, Davila RE, Hirota WK, Jacobson BC, Queshi WA et al. ASGE guideline: The role of endoscopy in acute non-variceal upper- GI hemorrhage. Gastrointest Endosc 2004;60:497-504.
28. 28. Petras RE, Gramlich TL. Gastrointestinal Pathology. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 3th ed. Philadelphia: Elsevier Inc; 2006:p.1207-231.