Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and nonvariceal gastrointestinal bleeding.Non-variceal upper gas...Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and nonvariceal gastrointestinal bleeding.Non-variceal upper gastrointestinal bleeding remains a common clinical problem globally.It is associated with high mortality,morbidity,and cost of the health care system.Despite the continuous improvement of therapeutic endoscopy,the 30-d readmission rate secondary to rebleeding and associated mortality is an ongoing issue.Available Food and Drug Administration approved traditional or conventional therapeutic endoscopic modalities includes epinephrine injection,argon plasma coagulation,heater probe,and placement of through the scope clip,which can be used alone or in combination to decrease the risk of rebleeding.Recently,more attention has been paid to the novel advanced endoscopic devices for primary treatment of the bleeding lesion and as a secondary measure when conventional therapies fail to achieve hemostasis.This review highlights emerging endoscopic modalities used in the management of non-variceal upper gastrointestinal related bleeding such as over-the-scope clip,Coagrasper,hemostatic sprays,radiofrequency ablation,cryotherapy,endoscopic suturing devices,and endoscopic ultrasound-guided angiotherapy.In this review article,we will also discuss the technical aspects of the common procedures,outcomes in terms of safety and efficacy,and their advantages and limitations in the setting of non-variceal upper gastrointestinal bleeding.展开更多
目的比较不同内镜方式治疗非静脉曲张上消化道出血(NVUGB)的效果。方法在Pubmed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数据库检索自建库以来至2018年11月公开发表的...目的比较不同内镜方式治疗非静脉曲张上消化道出血(NVUGB)的效果。方法在Pubmed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数据库检索自建库以来至2018年11月公开发表的、有关内镜治疗NVUGB的所有中英文随机对照试验(RCT),对纳入的研究进行质量评价,采用Revman 5.3软件进行Meta分析。结果经过文献筛选后,共37篇RCT最终被纳入分析,共3064例患者。Meta分析结果显示,金属钛夹与药物局部注射比较,即时止血成功率高(RR=1.12,95%CI:1.04~1.21)、再出血率低(RR=0.30,95%CI:0.22~0.42)、急诊外科手术率低(RR=0.24,95%CI:0.13~0.42);金属钛夹与热凝止血比较,再出血率低(RR=0.32,95%CI:0.16~0.65)、即时止血成功率差异无统计学意义(RR=0.96,95%CI:0.89~1.05)、急诊外科手术率差异无统计学意义(RR=0.43,95%CI:0.15~1.25);热凝止血与局部药物注射比较,即时止血成功率差异无统计学意义(RR=1.02,95%CI:0.98~1.05)、再出血率差异无统计学意义(RR=0.98,95%CI:0.76~1.27)、急诊外科手术率差异无统计学意义(RR=1.03,95%CI:0.75~1.41)。结论内镜下金属钛夹治疗NVUGB的疗效优于药物局部注射和热凝止血,具有临床推广和应用价值。展开更多
AIM To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane(NBCA + MS)] to treat nonvariceal upper gastrointestinal bleeding(NV-UGIB).METHODS In o...AIM To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane(NBCA + MS)] to treat nonvariceal upper gastrointestinal bleeding(NV-UGIB).METHODS In our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy's lesions, and 1 had duodenal diverticular bleeding.RESULTS Of the 45 patients treated endoscopically without initialhemostasis or with early rebleeding, 33(76.7%) were treated with modified cyanoacrylate glue, 16(37.2%) underwent surgery, and 3(7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS(23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients(78.8%): 19 out of 24(79.2%) during the first endoscopy and in 7 out of 9(77.8%) among early rebleeders. Two patients(22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded.CONCLUSION Modified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.展开更多
文摘Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and nonvariceal gastrointestinal bleeding.Non-variceal upper gastrointestinal bleeding remains a common clinical problem globally.It is associated with high mortality,morbidity,and cost of the health care system.Despite the continuous improvement of therapeutic endoscopy,the 30-d readmission rate secondary to rebleeding and associated mortality is an ongoing issue.Available Food and Drug Administration approved traditional or conventional therapeutic endoscopic modalities includes epinephrine injection,argon plasma coagulation,heater probe,and placement of through the scope clip,which can be used alone or in combination to decrease the risk of rebleeding.Recently,more attention has been paid to the novel advanced endoscopic devices for primary treatment of the bleeding lesion and as a secondary measure when conventional therapies fail to achieve hemostasis.This review highlights emerging endoscopic modalities used in the management of non-variceal upper gastrointestinal related bleeding such as over-the-scope clip,Coagrasper,hemostatic sprays,radiofrequency ablation,cryotherapy,endoscopic suturing devices,and endoscopic ultrasound-guided angiotherapy.In this review article,we will also discuss the technical aspects of the common procedures,outcomes in terms of safety and efficacy,and their advantages and limitations in the setting of non-variceal upper gastrointestinal bleeding.
文摘目的比较不同内镜方式治疗非静脉曲张上消化道出血(NVUGB)的效果。方法在Pubmed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数据库检索自建库以来至2018年11月公开发表的、有关内镜治疗NVUGB的所有中英文随机对照试验(RCT),对纳入的研究进行质量评价,采用Revman 5.3软件进行Meta分析。结果经过文献筛选后,共37篇RCT最终被纳入分析,共3064例患者。Meta分析结果显示,金属钛夹与药物局部注射比较,即时止血成功率高(RR=1.12,95%CI:1.04~1.21)、再出血率低(RR=0.30,95%CI:0.22~0.42)、急诊外科手术率低(RR=0.24,95%CI:0.13~0.42);金属钛夹与热凝止血比较,再出血率低(RR=0.32,95%CI:0.16~0.65)、即时止血成功率差异无统计学意义(RR=0.96,95%CI:0.89~1.05)、急诊外科手术率差异无统计学意义(RR=0.43,95%CI:0.15~1.25);热凝止血与局部药物注射比较,即时止血成功率差异无统计学意义(RR=1.02,95%CI:0.98~1.05)、再出血率差异无统计学意义(RR=0.98,95%CI:0.76~1.27)、急诊外科手术率差异无统计学意义(RR=1.03,95%CI:0.75~1.41)。结论内镜下金属钛夹治疗NVUGB的疗效优于药物局部注射和热凝止血,具有临床推广和应用价值。
文摘AIM To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane(NBCA + MS)] to treat nonvariceal upper gastrointestinal bleeding(NV-UGIB).METHODS In our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy's lesions, and 1 had duodenal diverticular bleeding.RESULTS Of the 45 patients treated endoscopically without initialhemostasis or with early rebleeding, 33(76.7%) were treated with modified cyanoacrylate glue, 16(37.2%) underwent surgery, and 3(7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS(23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients(78.8%): 19 out of 24(79.2%) during the first endoscopy and in 7 out of 9(77.8%) among early rebleeders. Two patients(22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded.CONCLUSION Modified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.
