Endoscopic Hemostasis in
Upper Gastrointestinal Bleeding Using Hemostatic Clips
Šťovíček J., Keil R., Burešová M., Goláňová J., Hrdlička L.
Interní klinika 2. lékařské fakulty UK a FN , Praha - Motol, přednosta doc. MUDr. Milan Kvapil, CSc. |
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Summary:
One of the endoscopy methods to stop upper gastrointestinal tract (GIT) bleeding in the limelight
these days is hemostasis using metal clips. This method is indicated especially in patients with
bleeding from an eroded artery and in patients where other hemostatic methods proved to be
unsuccessful. Goal of our work was to assess successfulness of hemostasis, percentage of early
rebleedings, and lethality of patients managed with this method. At the same time we present
indications and locations of bleedings in these patients. We have retrospectively evaluated
a group of 75 patients indicated for urgent endoscopy for GIT bleeding in a period from August
2000 till the end of February 2002. An average age of these patients was 69.7 years. We haven’t
managed to stop bleeding in 2 cases. In 12 patients (15.1 %) rebleeding appeared within two days
following intervention. From all the patients with early rebleeding: 4 patients had an ulcer and an
eroded artery in stomach (4 died from bleeding, one of them undergone a surgery), 4 patients had
an ulcer in duodenal bulb with artery at base (3 undergone surgery, 1 died), three patients had
esophageal bleeding, and one patient had bleeding from the suture in stomach wall (undergone
surgery and died). In majority of cases (82.8%) patients were managed with a combined technique
(clip + adrenaline injection). With regard to a location of lesions treated with clip application,
following locations were treated: esophagus 9.5%, stomach 40.5 %, pylori channel 2.7 %, duodenal
bulb 39.2 %, gastroenteroanastomosis 4.1 %, D2 4.1 %. Bleeding in 76 % of patients was from an
ulcer and artery (Forrest Ia, IIa). Results confirmed high effectivenes of hemostatic clips in
primary hemostasis of GIT bleeding – in our sample more than 95 %. An early rebleeding appeared
in 15 % of patients. Results presented correspond with data presented in world literature.
Key words:
Gastrointestinal bleeding - Endoscopy - Hemostasis - Clips
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