Management of Patients With Ulcer Bleeding

https://www.cghjournal.org/article/S1542-3565(08)00842-2/pdf

Endoscopic Therapy for Bleeding Ulcers: An Evidence-Based Approach Based on Meta-Analyses of Randomized Controlled Trials

https://www.giejournal.org/article/S0016-5107(08)01854-3/pdf

Endoscopic hemostasis in peptic ulcer bleeding for patients with high-risk lesions: a series of meta-analyses

https://www.giejournal.org/article/S0016-5107(96)70197-9/pdf

Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial.

BACKGROUND: Although endoscopic injection therapy is effective in controlling initial haemorrhage from peptic ulcer, between 10% to 30% of patients suffer rebleeding. AIM: To assess the factors that may predict the failure of endoscopic injection in patients bleeding from high risk gastric ulcer. SUBJECTS: One hundred and seventy eight patients admitted for a gastric ulcer with a bleeding or a non-bleeding visible vessel were included. METHODS: Patients received endoscopic therapy by injection for adrenaline and polidocanol. Twelve clinical and endoscopic variables were entered into a multivariate logistic regression model to ascertain their significance as predictive factor of therapeutic failure. RESULTS: Eighty seven per cent (155 of 178) of patients had no further bleeding after endoscopic therapy. Endoscopic injection failed in 23 (13%) patients: 20 (12%) continued to bleed or rebleed, and three (1%) patients could not be treated because of inaccessibility of the lesion. Logistic regression analysis showed that therapeutic failure was significantly related to: (1) the presence of hypovolaemic shock (p = 0.09, OR 2.38, 95% CI: 0.86, 6.56), (2) the presence of active bleeding at endoscopy (p = 0.02, OR 2.98, 95% CI: 1.12, 7.91), (3) ulcer location high on the lesser curvature (p = 0.04, OR 2.79, 95% CI: 1.01, 7.69), and (4) ulcer size larger than 2 cm (p = 0.01, OR 3.64, 95% CI: 1.34, 9.89). CONCLUSION: These variables may enable identification of those patients bleeding from gastric ulcer who would not benefit from injection therapy.

https://gut.bmj.com/content/gutjnl/39/2/155.full.pdf

Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer.

The injection of a mixture of ethanolamine oleate and thrombin as an effective treatment for bleeding duodenal ulcer was evaluated in 38 patients entered in a randomised prospective controlled trial. After a one week observation period, 1/19 (5.3%) treated patients and 11/19 (57.9%) control patients had suffered further bleeding (p less than 0.005; CI = 22%-74%). Emergency surgery was required in 1/19 in the treated group compared with 8/19 in the untreated group (CI = 13%-61%; p less than 0.05). The mean (SD) transfusion requirement in the treated group was 1.9 (0.5) U blood compared with 5.3 (0.7) U in the control group. No significant differences related to mortality were detected. In conclusion, local injection therapy is an effective means of haemostasis in patients with bleeding duodenal ulcer who are at risk of further bleeding.

https://gut.bmj.com/content/gutjnl/33/4/456.full.pdf

Endoscopic local injection of ethanolamine oleate and thrombin as an effective treatment for bleeding duodenal ulcer: a controlled trial.

Short term sclerotherapy (by injection(s) around the bleeding point) is used for immediate control of massive haemorrhage from oesophagogastric varices. The usefulness of longterm sclerotherapy once short term sclerotherapy has been successfully carried out was assessed. Two treatment groups were studied: 50 patients were treated by 'combined' (short term followed by longterm) sclerotherapy; 56 patients were treated by short term sclerotherapy only. Patients included in the second group were treated by short term sclerotherapy only if a variceal rebleeding was present. The overall cumulative proportion of patients rebleeding was not significantly different in either group. Combined sclerotherapy patients, however, experienced less episodes of variceal haemorrhage and the source of haemorrhage was different (p < 0.002). Combined sclerotherapy was more efficient in preventing bleeding from oesophageal bleeding points but not those arising from a junctional source (p < 0.05). A greater incidence of oesophageal rebleeding was found in those patients whose first source of bleeding was oesophageal (p < 0.05). No significant difference was detected in survival expectancy between either group. In conclusion, after short term sclerotherapy is carried out successfully, those patients with bleeding from variceal bleeding points located on oesophageal mucosa should benefit most from a longterm sclerotherapy programme.

https://gut.bmj.com/content/gutjnl/35/5/687.full.pdf

Combined (short-term plus longterm) sclerotherapy v short-term only sclerotherapy: a randomised prospective trial.

In reviewing 54 cases of granulomatous hepatitis (GH) diagnosed among 2,620 laparoscopies, we have been able to classify the capsular GH changes into five patterns: Macular, exudative, pinpoint, granular and cord-like The exudative pattern was the most frequent one, and predominated in brucellosis The granular pattern was most common in tuberculosis Furthermore, 35 additional cases, in whom a laparoscopic diagnosis of GH was not confirmed by liver biopsy, showed a trend to a final diagnosis consistent with multifocal diseases, whenever laparoscopic pictures were similar to the patterns described herein We speculate with the limits associated with the use of only a single biopsy sample We conclude that laparoscopy permits the establishment of a tentative diagnosis of GH, which could provide us with valuable information about the usefulness of obtaining multiple hepatic biopsies

Diagnostic yield and endoscopic patterns of laparoscopy in the diagnosis of granulomatous hepatitis.

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Endoscopic local injection of ethanolamine oleate and thrombin as an effective treatment for bleeding duodenal ulcer: a controlled trial.

Combined (short-term plus longterm) sclerotherapy v short-term only sclerotherapy: a randomised prospective trial.

Diagnostic yield and endoscopic patterns of laparoscopy in the diagnosis of granulomatous hepatitis.