Assessment of endoscopic Doppler to guide hemostasis in high risk peptic ulcer bleeding.

Details

Serval ID
serval:BIB_CF3452FADA90
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Assessment of endoscopic Doppler to guide hemostasis in high risk peptic ulcer bleeding.
Journal
Scandinavian journal of gastroenterology
Author(s)
Kantowski M., Schoepfer A.M., Settmacher U., Stallmach A., Schmidt C.
ISSN
1502-7708 (Electronic)
ISSN-L
0036-5521
Publication state
Published
Issued date
2018
Peer-reviewed
Oui
Volume
53
Number
10-11
Pages
1311-1318
Language
english
Notes
Publication types: Comparative Study ; Journal Article
Publication Status: ppublish
Abstract
Rebleeding or emergency surgery in failed endoscopic therapy of peptic ulcer bleeding are associated with high rates of morbidity and mortality. The clinical benefit of an endoscopic Doppler (ED) examination prior to endoscopic injection therapy was evaluated in high risk ulcer patients for rebleeding episode. Standard injection therapy (non-Doppler (ND)) was compared with targeted injection therapy after examination of the supplying vessel in the ulcer base by the ED.
Sixty patients with peptic ulcer bleeding (Forrest Ia-IIa; Rockall score of 5 or higher) were included in the study. Patients were assigned to ED or ND group with conventional therapy by chance. In the ND group injection was directed by the visual aspect of the ulcer, whereas in ED therapy was directed by ED.
Thirty-five patients were allocated to the ED group, and 25 to the ND group, respectively. No significant differences in patient or ulcer characteristics were observed regarding ulcer size, localization, Forrest classification or endoscopic treatment. Recurrent bleeding was observed in 7/35 (20%) in the ED group and in 13/25 (52%) of patients in the ND group (p = .013). Fewer ED patients needed surgery for rebleeding (1/35 vs. 6/25; p = .017). Bleeding related, but not all-cause mortality was significantly lower in the ED group (1/35 vs. 6/25, p = .017).
In this comparative analysis, use of ED to guide hemostatic therapy was associated with a significant reduction in recurrence of bleeding, surgical intervention and bleeding associated mortality.
Keywords
Adult, Aged, Aged, 80 and over, Endoscopy, Digestive System/methods, Female, Germany, Hemostasis, Endoscopic/methods, Humans, Male, Middle Aged, Peptic Ulcer Hemorrhage/diagnosis, Peptic Ulcer Hemorrhage/mortality, Peptic Ulcer Hemorrhage/surgery, Recurrence, Risk Assessment, Severity of Illness Index, Stomach/blood supply, Stomach Ulcer/diagnosis, Stomach Ulcer/surgery, Ultrasonography, Doppler/methods, Gastroduodenal ulcer, bleeding, endoscopic Doppler, hemostasis, mortality
Pubmed
Web of science
Create date
06/12/2018 15:54
Last modification date
20/08/2019 16:49
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