Treatment Of GI Bleeding Research Articles

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

CME Exam 1: Evaluation and Treatment of GI Bleeding in a 51-Year-Old Man

CME Exam 1: Evaluation and Treatment of GI Bleeding in a 51-Year-Old Man

Evaluation and Treatment of GI Bleeding in a 51-Year-Old Man

Question: A 51-year-old man with a history of hypertension presented to the emergency department for evaluation of rectal bleeding. He reported onset of diarrhea earlier in the day that turned black in color and changed into frank blood with clots. He had no known history of cirrhosis. On presentation, the patient was tachycardic with a pulse of 129 beats/min and hypotensive with a blood pressure of 89/46 mm Hg.

Mo1223 Lower Expression of PPARγ in AVM Tissue Provides a Novel Therapeutic Target for Use of Glitazones in Treatment of GI Bleeding: Validation of Our Large-Scale Clinical Effects Data Analysis

Mo1223 Lower Expression of PPARγ in AVM Tissue Provides a Novel Therapeutic Target for Use of Glitazones in Treatment of GI Bleeding: Validation of Our Large-Scale Clinical Effects Data Analysis

Successful Treatment of GI Bleeding with Octreotide in a Patient with Blue Rubber Bleb Nevus Syndrome and a Continued Need for Anticoagulation

Successful Treatment of GI Bleeding with Octreotide in a Patient with Blue Rubber Bleb Nevus Syndrome and a Continued Need for Anticoagulation

Focus and relevance in the management of GI bleeding

Gastroenterologists vary in their patient management skills. Besides obvious differences in their knowledge base, procedural dexterity, and bedside manner, what else differentiates “good” from “bad” gastroenterologists? Two failures in particular seem to frequently characterize ineffective management skills. The first failure relates to the inability to establish a management goal that addresses the underlying medical problem. The primary problem may be only partly recognized or may be missed altogether and instead the goal of medical management becomes focused on a secondary problem or an unimportant side issue. As each diagnosis presents itself with multiple clinical symptoms, laboratory findings, and test results, a gastroenterologist may choose to manage a secondary symptom rather than the primary problem or underlying disease. Similarly, the correction of an abnormal laboratory test value or the pursuit of an intermediate outcome parameter could easily become the false foci of medical attention. The second failure relates to the inappropriate selection of test and procedural options to achieve the chosen management goal. A selected test procedure could be wrong because it is unable to yield any answers relevant to the management goal. Besides being blatantly wrong, a test could also be less effective because of its low sensitivity or specificity compared with other available tests. Medical pursuits may, thus, become inefficient for reasons associated with the first or second type of failure or even with both types combined, when a physician is simultaneously unable to focus on the right goal and also unable to assess the sequence of chosen interventions with regard to their goal relevance. Obviously, these types of failures apply to the management of any digestive disease. Because GI bleeding is a frequent issue of consults to gastroenterologists and because a large portion of GI endoscopy centers on diagnosis and treatment of GI bleeding, issues of focus and relevance frequently manifest themselves in the management of GI bleeding. Several examples are discussed in the following section to illustrate this point.

Prospective Evaluation of a New High Power Argon Plasma Coagulation System (VIO APC) in Gastrointestinal Endoscopy: Experience with 216 Patients

Prospective Evaluation of a New High Power Argon Plasma Coagulation System (VIO APC) in Gastrointestinal Endoscopy: Experience with 216 Patients Hendrik Manner, Andrea May, Thomas Rabenstein, Lars Nachbar, Oliver Pech, Markus D. Enderle, Christian Ell Background: We sought to evaluate the safety and efficacy using a new high power argon plasma coagulation system (hp-APC) in the gastrointestinal tract.Methods: From 02/2005 to 06/2005, 216 patients (167 males (77.3%); mean age 66 G 11 years) were treated using hp-APC in a total of 275 sessions. In various indications (additive ablation therapy in curative intention in early Barrett’s cancer (132 patients); palliative treatment of esophageal cancer (n Z 20); gastric polyps/cancer (n Z 17); angiodysplasia (n Z 16); Zenker’s diverticulum (n Z 8); duodenal adenomas (n Z 7); and other), the new VIO APC device (VIO 300 D with APC 2; ERBE Elektromedizin, Tubingen, Germany) was used (pulsed APC; 15-120 W). Pushand-Pull Enteroscopy using double-balloon technique (PPE; new 1.5 mm APC probes) was used in 11 patients (5.1%). Safety and efficacy of hp-APC were recorded after each individual treatment session. Results: The mean number of treatment sessions required using hp-APC in various indications was 1.7 (1-5). For palliative tumor ablation therapy in the esophagus, it was 2.3 (1-5). Minor complications (pain, dysphagia, irritation of the intestinal wall) were observed in 24/216 patients (11.1%), major complications (gas accumulation in the intestinal wall, perforation, stenosis) in 5 patients (2.3%). Conclusions: Hp-APC appears to be safe and effective. Due to a low number of treatment sessions required, the VIO APC device might be used as an alternative to Nd:YAG laser in tumor debulking. Using the new 1.5 mm probes for PPE, hp-APC was effective in the treatment of GI bleeding.

Endoscopic Treatment of GI-Bleeding: Clipping, Injecting Or Smearing? Results from a Preclinical, Animal Study to Assess the Potential for Endoscopic Use of an Hemostatic Gelatin Matrix

Endoscopic Treatment of GI-Bleeding: Clipping, Injecting Or Smearing? Results from a Preclinical, Animal Study to Assess the Potential for Endoscopic Use of an Hemostatic Gelatin Matrix

Endoscopic treatment of Gi-Bleeding: Clipping, injecting or smearing?

Endoscopic treatment of Gi-Bleeding: Clipping, injecting or smearing?

Usefulness of endoscopic band ligation for bleeding small bowel vascular lesions

The optimal therapy for bleeding small bowel vascular lesions is controversial. This study investigated the efficacy and safety of endoscopic band ligation in this clinical condition. Fourteen patients bleeding from angiodysplasia and 4 bleeding from Dieulafoy's lesions located in the small bowel were included in this pilot study. Endoscopic band ligation was performed by using less than 200 mBar negative pressure in suctioning the target lesion into the ligation cap just before band release. Mean follow-up was 18 months (range 6-31 months). Endoscopic band ligation achieved hemostasis in a single session in all patients. No adverse events occurred except for mild abdominal pain in two patients. Mortality was null, and no patient required further blood transfusion during the 40 days after endoscopic band ligation. No patient with Dieulafoy's lesion had further bleeding, whereas bleeding recurred in 6 of 14 (43%) patients with angiodysplasia during long-term follow-up. Endoscopic band ligation is safe and effective for treatment of acutely bleeding small bowel vascular lesions. Although endoscopic band ligation is definitive therapy for Dieulafoy's lesion, long-term efficacy in the treatment of GI bleeding from angiodysplasia is limited.

A prospective, randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers

Background: Although endoscopic hemoclip therapy is widely used in the treatment of GI bleeding, there are few prospective trials that assess its efficacy. This study evaluated the efficacy and safety of hemoclip placement and distilled water injection for the treatment of high-risk bleeding ulcers. Methods: Seventy-nine patients with major stigmata of ulcer hemorrhage were randomly assigned to either endoscopic hemoclip placement (n = 39) or injection with distilled water (n = 40). Results: Initial hemostasis was achieved in all patients treated with hemoclips and 39 treated by distilled water injection (respectively, 100.0% vs. 97.5%; p = 1.00). Bleeding recurred in 4 and 11 of patients, respectively, in the hemoclip and water injection groups. It occurred significantly more frequently in the injection group (hemoclip, 10.3%; injection, 28.2%; p = 0.04). No major procedure-related complication occurred in either group. Emergency operations were performed in 5.1% of patients treated with hemoclips versus 12.5% of those in the water injection group (p = 0.43). Hospital days and mortality rate were similar in both groups. Conclusion: Endoscopic hemoclip placement is a safe and effective hemostatic method that is superior to distilled water injection for treatment of bleeding peptic ulcer. (Gastrointest Endosc 2003;57:324-8.)

3366 A comparison of endoscopic experience in 2- and 3- year gi training programs: canada vs us.

BACKGROUND: Endoscopy is a rapidly expanding field that has led to concerns regarding procedure competency thresholds. In Canada (CDA), extending the GI residency from 2 to 3 years, as in the United States (US), has been suggested but has not occurred. At present, it is not clear what the current endoscopy experience is for our GI trainees and how this compares with the US. AIM: To contrast the endoscopic experiences reported by trainees in core GI training programs in CDA and the US. METHODS: Surveys were distributed to fellows attending a combined National US/CDA Fellows' course in GI in 1999. Anonymous information regarding several aspects of training was requested on a voluntary basis, including forecasted tallies for various routine and advanced procedures (core training only). We asked respondents to evaluate the perceived impact of postcore GI training fellowships. Mean numbers of procedures for CDA and US were calculated. RESULTS: Both core GI trainees and research fellows attended (n=42 CDA; n=34 US). Survey respondents included 17 from CDA (6 adult GI programs), 17 from US (14 programs), and 4 from 2 pediatric GI programs in CDA. The procedure numbers from standard procedures are summarized in Table 1. Pediatric fellows, compared with adult trainees from CDA, had lower numbers of many procedures, eg. gastroscopy (159 fewer, 95%CI: 39-280), treatment of GI bleeding (51 fewer, 19-83), and colonoscopy (94 fewer, 26-162). 3 CDAs, from 3 programs, felt that post-core trainees had a negative impact on their endoscopic training vs 0 from US (p< 0.05). 5 (29%; 18-40) felt a 3^rdyear should be compulsory. CONCLUSIONS: US residents achieve a higher number of procedures over their 3 year program than CDA residents over 2 years. However, except for ERCP, both groups are meeting the ASGE guidelines for standard procedures.

What are the signs of recent hemorrhage, and what do they mean? Criteria for massive bleeding.

Hematemesis, melena, shock, vague symptoms, anemia, blood examinations and endoscopic findings are reviewed as signs of recent hemorrhage. An assessment of the condition of patients with upper GI bleeding is important for planning treatment. Therefore, in order to be able to evaluate a method of treatment of GI bleeding, reports referring to treatment of GI bleeding must contain a clear record of the severity of the patient's state and of the bleeding source. A common criterion for massive bleeding has been proposed. Specifically, a patient suffering from shock who needs more than 1,000 ml of blood or plasma expander by rapid transfusion within one hour, or more than 2,000 ml within the initial 24 hours, to stabilize his circulation, and whose Hb level is 8.0 g/dl or less, should be graded as having massive bleeding. Gastric ulcers with exposed blood vessels need endoscopic YAG laser hemostasis or ethanol injection therapy as quickly as possible, since 43% of the cases rebleed within 72 hours under conventional drug therapy, and such rebleeding can be prevented by the endoscopic hemostatic methods.