Peptic ulcer disease endoscopy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Therapeutic endoscopy is used to treat bleeding ulcer and recurrent ulcer.The second look endoscopy is done 24 hours after endoscopic therapy to check for bleeding. If there is bleeding after second look endoscopy, the next step is surgery or interventional radiology with transcatheter arterial embolization.
Endoscopic therapy
Indications for endoscopic therapy
- Patients with active spurting or oozing bleeding or a non-bleeding visible vessel
- Patients with an adherent clot resistant to vigorous irrigation[1]
Endoscopic therapy can be done by following methods:
- Injection therapy:
- Thermal coagulation:
- Contact type: Heater probe, monopolar and bipolar electrocoagulation
- Noncontact types : Laser treatment, argon plasma coagulation [APC][7]
- Mechanical devices: Endoclips and band ligation are used commonly[8][9]
- Combined therapy: Injection of diluted epinephrine followed by thermal coagulation[7]
- Hemospray: Nanopowder with clotting abilities is sprayed onto the bleeding site[10]
Endoscopic and Medical Therapy for Bleeding Ulcer
Approach to endoscopic therapy:*
| Bleeding ulcer | |||||||||||||||||||||||||||||||||||||
| Endoscopy | |||||||||||||||||||||||||||||||||||||
| Active bleeding or non-bleeding visible vessel | Adherent clot | Flat spot or clean base | |||||||||||||||||||||||||||||||||||
| Endoscopic therapies: •Injection therapy •Thermal coagulation •Mechanical therapy •Combined therapy •Hemospray | May consider Endoscopic therapies: •Injection therapy •Thermal coagulation •Mechanical therapy •Combined therapy •Hemospray | No endoscopic therapy | |||||||||||||||||||||||||||||||||||
| PPI or infusions | |||||||||||||||||||||||||||||||||||||
*Adopted:American college of gasteroenterology[11]
Second look endoscopy
- Second look endoscopy is done after 24 hours of endoscopic therapy
- This detect and treat ulcers that are at risk of recurrent bleeding
- This further reduces the episodes of recurrent bleeding
- Decrease the need of surgery to treat recurrent bleeding[12][13]
- If bleeding occurs after a second endoscopic therapeutic session, surgery or interventional radiology with transcatheter arterial embolization is done
References
- ↑ Laine L, McQuaid KR (2009). "Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials". Clin. Gastroenterol. Hepatol. 7 (1): 33–47, quiz 1–2. doi:10.1016/j.cgh.2008.08.016. PMID 18986845.
- ↑ Park CH, Lee SJ, Park JH, Park JH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ (2004). "Optimal injection volume of epinephrine for endoscopic prevention of recurrent peptic ulcer bleeding". Gastrointest. Endosc. 60 (6): 875–80. PMID 15605000.
- ↑ Cook DJ, Guyatt GH, Salena BJ, Laine LA (1992). "Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis". Gastroenterology. 102 (1): 139–48. PMID 1530782.
- ↑ Rutgeerts P, Rauws E, Wara P, Swain P, Hoos A, Solleder E, Halttunen J, Dobrilla G, Richter G, Prassler R (1997). "Randomised trial of single and repeated fibrin glue compared with injection of polidocanol in treatment of bleeding peptic ulcer". Lancet. 350 (9079): 692–6. PMID 9291903.
- ↑ Chung SC, Leong HT, Chan AC, Lau JY, Yung MY, Leung JW, Li AK (1996). "Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial". Gastrointest. Endosc. 43 (6): 591–5. PMID 8781939.
- ↑ Scharnke W, Hust MH, Braun B, Schumm W (1997). "[Complete gastric wall necrosis after endoscopic sclerotherapy for a gastric ulcer with visible arterial stump]". Dtsch. Med. Wochenschr. (in German). 122 (19): 606–9. doi:10.1055/s-2008-1047662. PMID 9182025.
- ↑ 7.0 7.1 Lin HJ, Tseng GY, Perng CL, Lee FY, Chang FY, Lee SD (1999). "Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding". Gut. 44 (5): 715–9. PMC 1727515. PMID 10205211.
- ↑ Ohta S, Yukioka T, Ohta S, Miyagatani Y, Matsuda H, Shimazaki S (1996). "Hemostasis with endoscopic hemoclipping for severe gastrointestinal bleeding in critically ill patients". Am. J. Gastroenterol. 91 (4): 701–4. PMID 8677932.
- ↑ Scapa E (1997). "Treating gastrointestinal bleeding with endoscopic hemoclips". Surg Laparosc Endosc. 7 (2): 94–6. PMID 9109234.
- ↑ Sung JJ, Luo D, Wu JC, Ching JY, Chan FK, Lau JY, Mack S, Ducharme R, Okolo P, Canto M, Kalloo A, Giday SA (2011). "Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding". Endoscopy. 43 (4): 291–5. doi:10.1055/s-0030-1256311. PMID 21455870.
- ↑ "Management of Patients with Ulcer Bleeding | American College of Gastroenterology".
- ↑ Chiu PW, Lam CY, Lee SW, Kwong KH, Lam SH, Lee DT, Kwok SP (2003). "Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial". Gut. 52 (10): 1403–7. PMC 1773815. PMID 12970130.
- ↑ Villanueva C, Balanzó J, Torras X, Soriano G, Sáinz S, Vilardell F (1994). "Value of second-look endoscopy after injection therapy for bleeding peptic ulcer: a prospective and randomized trial". Gastrointest. Endosc. 40 (1): 34–9. PMID 8163132.