Treatment Of Upper Gastrointestinal Bleeding Research Articles

Perforation of a peptic ulcer with migration of hemostatic clips: a rare complication in the treatment of upper gastrointestinal haemorrhage

Abstract Hemostatic clips are one of the most common treatment options for upper gastrointestinal haemorrhage, allowing for monotherapy in Forrest IIa or higher-grade bleeding. Complications associated with them are infrequent, limited to erosions and minor bleeding related to their deployment. We present the case of a patient with upper gastrointestinal haemorrhage secondary to a duodenal peptic ulcer. The patient was treated using a combination of various hemostatic methods, which resulted in perforation of the ulcer and migration of a hemostatic clip into the duodeno-pancreatic groove.

The Effect of a Teaching Program on Knowledge, Practice, and Response Time of Nurses Regarding the Management of Upper Gastrointestinal Bleeding

Background: Gastrointestinal bleeding is one of the emergencies that all therapeutic measures should be performed effectively and efficiently in a short time. This study aims to determine the effectiveness of an educational program on the improvement of nurses' knowledge, performance, and response time in the care of patients with upper gastrointestinal bleeding in the Emergency Department. Methods: This quasi-experimental study employed a single group pre-test and post-test design and was conducted at the Emergency Room of the Institute of Liver and Biliary Sciences (ILBS), New Delhi, India. A total of 20 nurses working in the Emergency Room were recruited through enumeration. Also, 35 events before and 35 events after the intervention were observed. The educational program was implemented through face-to-face lecture-cum discussion in six 30-minute sessions and groups of 3 to 4 nurses over three days. A researcher-made questionnaire was used to measure nurses’ knowledge regarding upper gastrointestinal bleeding, and their performance and response time were observed and calculated through a checklist. The data were described and analyzed using descriptive statistics, the paired t-test, the Kruskal-Wallis H test, and the Mann-Whitney U test in SPSS software, version 20. The significance level was set at P≤0.05. Results: A noticeable improvement in the scores of knowledge and performance and a significant decrease in the nurses’ response time were observed (P<0.001). Also, there was a significant relationship between the knowledge score and the work experience of nurses in the Emergency Department (P=0.018). Conclusion: Periodic evaluation of nurses’ performance in the care and treatment of upper gastrointestinal bleeding emergencies through observation and checklist is recommended. In-service training courses regarding managing upper gastrointestinal bleeding seem to be necessary.

Single-session endoscopic ultrasound-directed transgastric endoscopy for treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass.

Single-session endoscopic ultrasound-directed transgastric endoscopy for treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass.

Evaluation of a single-use gastroscope in patients presenting with suspected upper gastrointestinal hemorrhage: a pilot feasibility study (One-Scope I).

BACKGROUND : Outbreaks of multidrug-resistant bacteria due to contaminated duodenoscopes and infection risks during the COVID-19 pandemic have driven the development of single-use endoscopes. The first single-use gastroscope is now available in Europe. Besides waste disposal and cost issues, the infection risk and performance remain unclear. We aimed to evaluate a single-use gastroscope in patients with signs of upper gastrointestinal bleeding. METHODS : 20 consecutive patients presenting with clinical signs of upper gastrointestinal bleeding between October and November 2022 were included in this case series. The primary aim was technical success, defined as access to the descending duodenum and adequate assessment of the upper gastrointestinal tract for the presence of a bleeding site. RESULTS : The primary aim was achieved in 19/20 patients (95 %). The bleeding site was identified in 18 patients. A therapeutic intervention was performed in six patients (two cap-mounted clips, one standard hemostatic clip, two variceal band ligations, one hemostatic powder, two adrenaline injections); technical and clinical success were achieved in all six patients. Two crossovers to a standard gastroscope occurred. CONCLUSIONS : Use of single-use gastroscopes may be feasible for patients presenting for urgent endoscopic evaluation and treatment of upper gastrointestinal bleeding.

Practical Aspects of Upper Gastrointestinal Bleeding in Children.

Upper gastrointestinal bleeding (UGB) in children is a potentially life-threatening condition that represents a challenge for pediatricians and pediatric surgeons. It is defined as bleeding from any location within the upper esophagus to the ligament of Treitz. UGB can have many causes that vary with age. The impact on the child is often proportional to the amount of blood lost. This can range from mild bleeding that is unlikely to cause hemodynamic instability, to massive bleeding that requires admission to the intensive care unit. Proper and prompt management are very important factors in reducing morbidity and mortality. This article aims to summarize current research regarding the diagnosis and treatment of UGB. Most of the data used in the literature published on this subject is extrapolated from adulthood.

Effects of gastrointestinal endoscopy at different time points on diagnosis and treatment of upper gastrointestinal bleeding in patients with liver cirrhosis.

Liver cirrhosis is a common diffuse and persistent liver disease in the gastroenterology department. To assess the effects of gastrointestinal endoscopy at different time points on the diagnosis and treatment of upper gastrointestinal bleeding (UGIB) in patients with liver cirrhosis. The clinical data of 102 liver cirrhosis patients with UGIB admitted from July 2020 to May 2022 were retrospectively analysed. According to the timing of the first gastroscopy after hospitalization, the patients were divided into 4 groups: Group A (n = 25, gastroscopy performed within 12 h of the first bleeding), Group B (n = 29, gastroscopy performed within 12-48 h of the first bleeding), Group C (n = 25, elective gastroscopy performed > 48 h after the first bleeding), and Group D (n = 23, emergency gastroscopy was conducted due to active bleeding manifestations after failure of medication). The success rate of haemostasis in Group A was higher than in Groups B-D (p < 0.05). The early rebleeding rates of the 4 groups were similar (p > 0.05). After treatment, the levels of serum malondialdehyde and lipid hydrogen peroxide declined but the levels of glutathione peroxidase and superoxide dismutase rose in all groups compared to those immediately after hospitalization (p < 0.05), and these indicators were improved more significantly in Group A (p < 0.05). Gastroscopy performed within 12 h of the first bleeding is more conducive to improving the haemostatic effect and thus shortening the length of hospital stay.

Diagnosis and Treatment of Upper Gastrointestinal Bleeding for the Primary Care Physician

Diagnosis and Treatment of Upper Gastrointestinal Bleeding for the Primary Care Physician

Diagnosis and Treatment of Upper Gastrointestinal Bleeding for the Primary Care Physician

Upper gastrointestinal bleeding (UGIB) is a highly prevalent medical-surgical emergency that must be treated early due to its high morbidity and mortality. It presents as bleeding from the esophagus, stomach or proximal duodenum, and is divided into non-variceal and variceal etiology. Among non-variceal ulcers, peptic ulcer stands out as the most frequent, being this produced by an imbalance between protective and aggressive factors. On the other hand, in variceal-type hemorrhages, gastroduodenal varices stand out, which are a consequence of increased portal pressure. The incidence of UGIB worldwide varies considerably between literature and mortality between 5 and 14% according to different studies. Unfortunately, there are no reliable national figures for incidence and prevalence. The physician must have a good understanding of the clinical presentation and pathophysiology in order to be assertive in the suspicion, diagnosis and management of this pathology. Regarding treatment, the confrontation is divided into emergency management and then endoscopic management, since early intensive resuscitation can reduce morbidity and mortality in patients with upper gastrointestinal bleeding.

Role of Transcatheter Arterial Embolization in Acute Refractory Non-variceal Upper Gastrointestinal Bleeding Not Controlled by Endoscopy: A Single-Center Experience and a Literature Review.

Introduction Acute upper gastrointestinal bleeding (UGIB) is a medical emergency and a common cause of hospital admissions worldwide. It has traditionally been treated with resuscitation and endoscopic intervention as the first-line therapy. In this study, weassessed the adjunctive role of transcatheter arterial embolization (TAE) in patients with uncontrolled UGIB after an endoscopic intervention. Material and methods A retrospective chart review of patients requiring TAE of UGIB which was not controlled by endoscopic intervention in BronxCare Health System from 2018 to 2021 was done. Patients who were more than 18 years of age and required TAE during the time period of the study were included in the study. Patients' charts were reviewed for patients' demographics, comorbidities, hospital course, imaging findings, esophagogastroduodenoscopy findingsand intervention, and interventional radiology intervention and clinical outcome. Results A total of 10 patients were included in the study. A majority of the patients were male. Transcatheter atrial embolization was successful in all the 10 patients. Coils were used in seven patients while particulate polyvinyl alcohol 500 micronparticlewas used in two patients and vascular plug was used in two patients. Out of the 10 patients, four expired during the hospital course. None of the patients died secondary to UGIB. Three of the patients expired due to severe sepsis with septic shock secondary to pneumonia while one patient died because of respiratory failure due to lung collapse secondary to endobronchial lesion. Conclusion Refractory acute UGIB is associated with significant morbidity and mortality. TAE is a minimally invasive measure that should be considered early in the treatment of UGIB which is refractory to conventional endoscopic management. Our case highlights the importance of TAE in a patient with refractory UGIB after endoscopic intervention.

S2642 Rare Case of Upper Gastrointestinal Bleeding Secondary to Hepatocellular Carcinoma

Introduction: Among gastrointestinal pathologies, gastrointestinal bleeding (GIB) is the most common cause of hospitalization within the United States, and consequently costing the healthcare system $5 billion.1 Common causes of upper gastrointestinal bleeding(UGIB) are gastric or duodenal ulcers, gastritis or duodenitis, and esophagitis. We present a rare case of hepatocellular carcinoma (HCC) extending into the duodenum causing an UGIB. Case Description/Methods: 64 year old male with history of alcohol abuse, developed multifocal HCC and decompensated cirrhosis presents with fatigue and weakness. Additionally, patient has multiple admissions for UGIB stabilized by gastroduodenal artery embolization after failing endoscopic treatment. At admission, patient was hypotensive at 100/57 and anemic with a hemoglobin 5.8. Computed tomography and angiogram showed a exophytic lesion supplied by the cystic artery eroding into the duodenal bulb. Band and coil embolization of the tumoral arteries arising from the cystic artery was performed. The patient had worsening hematochezia and hemodynamic instability, and deemed inoperable. He was not a transplant candidate given his cancer burden and later expired. (Figure) Discussion: Esophagogastroduodenoscopy (EGD) and angioembolization play vital roles in treatment of UGIB and surgery is used as salvage therapy. EGD is used to provide diagnosis and therapy. In an acute setting the Glasgow Blatchford Score (GBS) is used for risk assessment. EGD within 24 hours is recommended for patients and within 12 hours for variceal bleeding. A combination of thermal and nonthermal coagulation, submucosal injection, and clipping can facilitate hemostasis. Contact thermal therapy, includes bipolar and unipolar cautery, allows for pressure application at the bleeding point with thermal energy for the coagulation. Non-contact thermal technique such as argon plasma coagulation uses ionized argon gas to ablate hemorrhagic tissue. Multiple nonthermal techniques including injection sclerotherapy and clipping. Injection sclerotherapy consists of injections of epinephrine, or other substances, surrounding the bleeding site with thermal therapy. Angioembolization is used for bleeding when endoscopic interventions fail. A tumor rupture is life-threatening and there are limited reports of UGIB secondary to HCC, emphasizing the importance of our case.Figure 1.: A: Prior gastroduodenal artery embolization B: Proper hepatic artery C: Common hepatic artery D: Left hepatic artery E: Right hepatic artery F: Cystic artery.

TC-325 hemostatic powder in the management of upper gastrointestinal malignant bleeding: a randomized controlled trial.

Background and study aims Upper gastrointestinal bleeding (UGIB) from malignancy is associated with high rebleeding and mortality rates. Recently, TC-325 powder has shown promising results in the treatment of UGIB, including malignant bleeding. The aim of this study was to compare the efficacy of TC-325 versus best clinical management. Patients and methods From August 2016 to February 2020, all patients with evidence of UGIB from malignancy were randomized to receive TC-325 therapy or control group, in which endoscopic treatment was not mandatory. Exclusion criteria were hemoglobin drop without overt bleeding and UGIB from non-tumor origin. The primary outcome was 30-day mortality. Secondary outcomes were 30-day rebleeding, blood transfusion and length of hospital stay. Results Sixty-two patients were randomized, three were excluded and 59 were included in the final analysis (TC-325 group = 28; control = 31). Groups were similar at baseline. Active bleeding was observed in 22 patients in the TC-325 group and 19 in the control group ( P = 0.15). Successful initial hemostasis with TC-325 was achieved in all cases. Additional therapy (radiotherapy, surgery or arterial embolization) was equally performed in both groups (42.9 % vs 58.1 %; P = 0.243). There were no differences in 30-day mortality (28.6 % vs. 19.4 %, P = 0.406) or 30-day rebleeding rates (32.1 % vs. 19.4 %, P = 0.26). Logistic regression identified no significant predictors of rebleeding. Age, Eastern Cooperative Oncology Group (ECOG) score 3 to 4 and AIMS65 score > 1 predicted greater mortality. Conclusions TC-325 was effective in achieving immediate hemostasis in malignant gastrointestinal bleeding but did not reduce 30-day mortality, 30-day rebleeding, blood transfusion or length of hospital stay. Age, ECOG 3–4, and AIMS65 > 1 were predictive factors of mortality.

Effects of Vitamin C Combined with Growth Inhibitors on Gastrointestinal Bleeding in Cirrhosis.

The purpose of this study was to investigate the effect of vitamin C combined with growth inhibitors on serum miR-130a, nitric oxide (NO), and hemostasis in the treatment of upper gastrointestinal bleeding (UGIB) in cirrhosis. Eighty patients with cirrhosis UGIB treated in our hospital from March 2021 to March 2022 were selected and divided into two groups using the random number table method. The control group received growth inhibitor treatment, while the observation group was given vitamin C combined with growth inhibitor treatment for 3 d. The hemostatic effect, serum laboratory indexes (miR-130a, NO), liver function indexes (aspartate aminotransferase (AST), alanine aminotransferase (ALT)), adverse effects, and 24 h hemostasis rate were compared between the two groups. The hemostasis time in the observation group was shorter than that in the control group, and the blood transfusion volume was lower than that in the control group. There was no statistical difference regarding the portal blood flow, miR-130a, NO, AST, and ALT indexes between the two groups before treatment. After treatment, the portal blood flow, miR-130a, NO, AST, and ALT indexes in both groups were lower than those before treatment, and all of them were lower in the observation group than in the control group. Adverse reactions showed no significant difference between the two groups of patients with cirrhosis UGIB,, while the 24 h hemostasis rate in the observation group (97.50%) was significantly higher than that in the control group (77.50%). Vitamin C combined with growth inhibitor was effective in the treatment of cirrhotic UGIB, which could effectively shorten the hemostasis time, reduce the transfusion volume and portal blood flow, and improve miR-130a, NO, and liver function levels of patients, with higher safety, and is worthy of clinical promotion.

Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study

BackgroundGastrointestinal bleeding is one of the major gastrointestinal diseases. In this study, our objective was to compare Glasgow-Blatchford score (GBS), AIMS65 score, MAP score, Modified GBS, and Iino score as outcome measures for upper gastrointestinal bleeding. In addition, we extracted factors associated with hemostatic procedures including endoscopy, and proposed a new robust score model.MethodsFrom January 2015 to December 2019, 675 patients with symptoms such as hematemesis who visited the National Hospital Organization Disaster Medical Center and underwent urgent upper endoscopy with diagnosis of suspected non-variceal upper gastrointestinal bleeding were retrospectively reviewed. We evaluated the GBS, AIMS65 score, MAP score, Modified GBS, and Iino score, and assessed the outcomes of patients requiring hemostatic treatments at the subsequent emergency endoscopy. We performed logistic regression analysis of factors related to endoscopic hemostasis and upper gastrointestinal bleeding, created a new score model, and evaluated the prediction of hemostatic treatment and mortality in the new score and the existing scores.ResultsThe factors associated with endoscopic treatment were hematemesis, heart rate, HB (hemoglobin), blood pressure, blood urea nitrogen (BUN). Based on these predictors and the partial regression coefficients, a new score named H3B2 (using the initial letters of hematemesis, heart rate, HB, blood pressure, and BUN) was generated. H3B2 score was slightly more discriminatory compared to GBS and Modified GBS (area under the receiver operating characteristic curves (AUROC): 0.73 versus 0.721 and 0.7128, respectively) in predicting hemostatic treatment in emergency endoscopy. The H3B2 score also showed satisfactory prediction accuracy for subsequent deaths (AUROC: 0.6857. P < 0.001).ConclusionsWe proposed a new score, the H3B2 score, consisting of simple and objective indices in cases of suspected upper gastrointestinal bleeding. The H3B2 score is useful in identifying high-risk patients with suspected upper gastrointestinal bleeding who require urgent hemostatic treatment including emergency endoscopy.

Lower Gastrointestinal Bleeding: Current State of Diagnosis and Treatment and Interpretation of the Clinical Guidelines

Lower gastrointestinal bleeding (LGIB) is a common clinical emergency. However, most of the published findings on LGIB were of retrospective or observational studies, and the relevant clinical guidelines and consensuses were not published until quite recently. In clinical practice, LGIB treatment is not as standardized as the treatment of upper gastrointestinal bleeding. Herein, on the basis of the latest clinical research findings on and guidelines for LGIB, we summarized and analyzed the existent diagnosis and treatment of LGIB from the perspectives of patient assessment and endoscopic, interventional and medication treatment, intending to provide more references to support the clinical practice.

Modern Technologies of Endoscopic Hemostasis in the Treatment of Ulcer Gastroduodenal Bleeding: A Literature Review

The treatment of upper gastrointestinal bleeding (UGIB) remains one of the complex problems of clinical practice. In the structure of UGIB, 30%-60% of cases are occupied by bleeding of ulcerative etiology. Success in treating patients with ulcerative gastroduodenal bleeding is possible only with the use of an integrated approach that includes endoscopic, medicinal, endovascular, and surgical hemostasis technologies. In contrast, endoscopic hemostasis (EH) is crucial in the treatment of such patients. The use of modern advances in endoscopy can significantly improve the treatment results of patients with UGIB, reducing the number of operations and mortality in this severely affected group of patients. Modern therapeutic endoscopy has a wide arsenal of tools that can reliably stop bleeding. They differ from each other in the nature of impact, effectiveness, availability, safety, and cost. This article presents an overview of the technological and clinical features of hemostasis, modern views on the choice and application of methods of EH for ulcerative gastroduodenal bleeding.

Intermittent Versus Continuous Infusion Dosing of Intravenous Proton Pump Inhibitors for Upper Gastrointestinal Bleeding.

Proton pump inhibitor (PPI) continuous infusions or intermittent boluses are used for the treatment of upper gastrointestinal bleeding (UGIB). Intermittent boluses are easier to give and are of lower cost without affecting clinical outcomes. To compare the rate of rebleeding between intermittent bolus and continuous infusion PPI therapy. We performed a retrospective, multicenter review of patients with UGIB receiving either continuous or intermittent PPI therapy. During the study period, due to drug and supply shortages, each institution implemented policies preferring intermittent PPI bolus therapy. We performed bivariate and multivariable comparisons of the 2 treatment strategies, with the primary outcome of interest being incidence of rebleeding. Additional variables of interest included intensive care unit (ICU) and hospital lengths of stay, discharge disposition, and in-hospital mortality. Compared with intermittent bolus dosing (n = 209), patients receiving continuous infusion PPI (n = 237) were associated with a higher rate of rebleeding (33.8% vs 23.0%; P = 0.012); however, no difference was detected in multivariable analysis: adjusted odds ratio, 1.50 (95% confidence interval, 0.91-2.50). There was no difference in median hospital or ICU length of stay, discharge disposition, or in-hospital mortality. Correlatively, patients receiving continuous infusion therapy were more likely to have liver disease (29.1% vs 20.1%; P = 0.028), alcohol use disorder (28.3% vs 16.3.%; P = 0.003), history of lower gastrointestinal bleeding (6.4% vs 1.9%; P = 0.021), variceal bleeding (6.3 vs 2.4%, P = 0.045), and be admitted to the ICU (65.0% vs 32.5%, P = 0.00). Introduction of intermittent PPI bolus UGIB treatment via change in hospital policy was not associated with higher rates of rebleeding. However, continuous PPI therapy may have been perceived as more effective as it was used more commonly in high-risk patients.

Effect of Rabeprazole and Rebamipide in the Treatment of Upper Gastrointestinal Hemorrhage Associated with Dual Antiplatelet Therapy in Elderly Patients with Coronary Heart Disease.

To investigate the therapeutic effect of rabeprazole and rebamipide on patient age over 60 with dual antiplatelet therapy (DAPT)-related upper gastrointestinal hemorrhage following percutaneous coronary intervention (PCI). A total of 360 patients age over 60 undergoing PCI were recruited for antiplatelet therapy involving a combined treatment of aspirin (100 mg/d) and clopidogrel (75 mg/d). The enrolled patients were divided into 4 groups: the control group, the rabeprazole group, the rebamipide group, and the rabeprazole + rebamipide group. The incidence and severity of any upper gastrointestinal hemorrhage and the incidence of major adverse cardiac events (MACEs) were observed 6 months after the operation. The incidence of upper gastrointestinal hemorrhage in the 4 groups was 11.1%, 3.3%, 8.9%, and 1.1%, respectively, and the differences were statistically significant (P < 0.05). On comparing the groups, the differences between the control group and the rabeprazole group, those between the control group and the rabeprazole + rebamipide group, and those between the rebamipide group and the rabeprazole + rebamipide group were found to be statistically significant (P < 0.05). The severity of the upper gastrointestinal hemorrhage in the rabeprazole group and the rabeprazole + rebamipide group was significantly lower than that in the control group. The 4 groups exhibited no significant differences in the incidence of MACEs (P > 0.05). For patients age over 60 receiving DAPT following PCI in our study population, treatment with rabeprazole or a combination of rabeprazole and rebamipide could reduce the risk of upper gastrointestinal hemorrhage, as well as reduce its severity.

Massive Upper Gastrointestinal Bleeding.

This case is targeted to emergency medicine residents of all levels. Upper gastrointestinal bleeding (UGIB) is a common chief complaint encountered in the emergency department, resulting in over 500,000 hospitalizations and 20,000 deaths annually in the United States.1 The diagnosis and management of UGIB in stable patients is typically fairly straightforward. However, there are a number of circumstances where the treatment of UGIB is much more challenging, and emergency medicine (EM) physicians should be familiar with, and have experience managing, these difficult presentations. Massive UGIB can necessitate the need for management of a difficult airway in the setting of airway contamination, as well as placement of a gastroesophageal balloon tamponade device. The appropriate use and indications for performing this high-risk/low-frequency procedure requires dedicated practice. Furthermore, the management of gastrointestinal hemorrhage in a patient with a religious objection to the administration of blood products, including Jehovah's Witnesses, can be especially challenging and requires knowledge of alternative therapies to support blood pressure, oxygen carrying capacity, and decrease coagulopathy.2,3. By the end of this simulation, learners will be able to: 1) manage a hypotensive patient with syncope and hematemesis, 2) pharmacologically manage an acute UGIB addressing the various causes, 3) recognize worsening clinical status and intervene by performing difficult airway management, 4) place a gastroesophageal balloon tamponade device. This simulation was conducted with a high-fidelity mannequin with a separate medium-fidelity intubating mannequin that was modified to allow rapid filling of the oropharynx with simulated blood. Due to the COVID-19 pandemic, a total of six EM residents in various levels of training participated in the simulated patient encounter while the rest of the learners watched the simulation and participated in the debrief via video conference. Following the simulation and debrief session, all the residents, including those who participated in-person and via video conference, were sent a survey via surveymonkey.com to assess the educational quality of the simulation. Overall residents expressed positive feedback on the scenario, noting that the case was realistic, appropriately complex, and improved their medical knowledge and procedural skills. This case has a mixture of high-fidelity and medium-fidelity components which can be easily reproduced. The case was extremely useful in teaching EM residents of all levels not only how to manage large volume UGIB in a patient who is also a Jehovah's Witness, but also how to manage the airway and place a gastroesophageal balloon tamponade device. The case starts with a patient presenting with syncope and as the case unfolds, the patient's clinical status deteriorates, requiring learners to resuscitate, intubate, and obtain a gastroesophageal balloon tamponade.Residents commented that managing this case of an UGIB was extremely challenging because it exposed and filled important gaps in both their knowledge and procedural skills. Residents struggled most with identifying alternative therapies to blood products in patients with religious objections, and the step-by-step process of placing a Blakemore tube. Upper gastrointestinal bleed, hemorrhagic shock, Jehovah's Witness, difficult airway.

Application of Digestive Endoscopy in the Treatment of Upper Gastrointestinal Hemorrhage

Application of Digestive Endoscopy in the Treatment of Upper Gastrointestinal Hemorrhage

Intravenous Drip of Somatostatin Followed by Restricted Fluid Resuscitation to Treat Upper Gastrointestinal Bleeding in Patients with Liver Cirrhosis.

Objective Liver cirrhosis is a common, often progressive, and usually fatal disorder. Upper gastrointestinal bleeding is a leading cause of death in patients with liver cirrhosis. The purpose of this study was to evaluate the effectiveness of somatostatin combined with restricted fluid resuscitation in the treatment of upper gastrointestinal bleeding in the patients with liver cirrhosis. Methods From January 2018 to December 2020, 84 patients with liver cirrhosis complicated by upper gastrointestinal bleeding admitted to the Department of Gastroenterology of Ningbo Yinzhou No. 2 Hospital were selected as study participants. They were randomly assigned into the study group (n = 42) and control group (n = 42). All patients were given intravenous drip of somatostatin. The study group was supplemented with restricted fluid resuscitation therapy. The hemoglobin (Hb), platelet, fibrinogen, hematocrit, transfusion volume of red blood cells, hemostatic time, hemostatic rates in 0 h–24 h, 24 h–48 h, and >48 h, rebleeding rates, resuscitation rate, and incidence rates of complications were compared between the two groups 48 h after treatment. Results It was found that the Hb, platelet, fibrinogen, and hematocrit were notably increased in the study group compared to the control group 48 h after treatment (P < 0.01). The proportion of patients with excellent response was notably higher in the study group than in the control group (P < 0.05). The overall response rate of the study group was 90.48%, which was significantly higher than 71.43% in the control group (P < 0.05). The study group had lower transfusion volume of red blood cells, shorter hemostatic time, and lower rebleeding rates than the control group (P < 0.01). The hemostatic rate of 0 h–24 h in the study group was remarkably higher than that in the control group (P < 0.05). The hemostatic rate of >48 h in the study group was lower than that in the control group (P < 0.05). The overall incidence rate of complications in the study group was 9.52%, which was significantly lower than 30.95% in the control group (P < 0.05). Conclusion These data suggest that intravenous drip of somatostatin followed by restricted fluid resuscitation leads to a better clinical efficacy in treating upper gastrointestinal bleeding in patients with liver cirrhosis considering higher resuscitation rate and hemostatic rate and reduced incidence of complications, which is conducive to the recovery of patients and worthy of further clinical promotion.