Aralik 2008
Son 15 yilda akut üst gastrointestinal sistem kanamasi olan hastalarin endoskopik bulgularinda ne degisti?
Endoscopic findings in patients admitted with acute upper gastrointestinal system bleeding: What has changed in the past 15 years?
- Ana Sayfa
- Sayılar
- Aralik 2008
- Son 15 yilda akut üst gastrointestinal sistem kanamasi olan hastalarin endoskopik bulgularinda ne degisti?...
Özet
Giris ve Amaç: Üst gastrointestinal sistem kanamasi nedenleri, görülme sikliklari, tedavi sekilleri altta yatan hastaliklarin tedavisindeki gelismelere veya görüntüleme yöntemlerindeki teknik gelismelere bagli olarak zamanla degisecektir. Klinigimizce 15 yil önce ve simdi bir kesit alinarak bu farki ortaya koymaya çalistik. Gereç ve Yöntem: Klinigimizde 15 yil ara ile iki ayri 15 aylik kesitte kanama nedeniyle üst endoskopi yapi lan hastalarin inceleme sonuçlari karsilastirildi. Bulgular: Son 15 ayli k kesitte degerlendirilen 240 hastanin 169’u erkek, 71’i kadin olup ortalama yaslari 57.3 (14-86) idi. Olgularin 97’si (%40.4) 60 yas üzerindeydi. 1993 yili 15 aylik kesitte ise olgularin yas ortalamasi 47.5 (12-84) ve bunlarin %37’si de 60 yas üzerindeydi. 2008’de hastalarin %36.2’inde aktif kanama vardi ve bu hastalarin %82.7’si enjeksiyonla, %12.6’si argon plazma koagulasyonla, %4.6’si heater probe ile tedavi edildi. Bunun yaninda 1993 yilinda hastalarin %26’sinda aktif kanama odagi saptandi ve tüm olgular enjeksiyon yöntemi ile tedavi edildi. Ayrica yillar içinde duodenal ülsere bagli kanama sikliginin (%56’ya %42) anlamli oranda azaldigi (p<0.05), varislere bagli kanamanin (%9.6’ya %7.4) da bir miktar azaldigi (p>0.05) saptandi. Ayrica Dieulafoy ve anjiodisplazi gibi lezyonlar saptanmaya baslandi (1993’te hiç tanimlanmazken 2008’de %2.88). Sonuç: Helikobakter pilori’nin en önemli duodenal ülser sebebi oldugu göz önüne alinirsa, 15 yil öncesine göre daha iyi eradikasyon oranlarina bagli olarak duodenal ülsere bagli kanamalar azalmi s olabilir. 15 yil öncesine göre varis kanamasi sikliginin azalmasi da portal hipertansiyonun daha etkili medikal tedavisi ile ilgili olabilir. Arteriovenöz malformasyon ve Dieulafoy gibi lezyonlarin taninabilir olmasi klinigin tecrübe kazanmasi ve endoskop cihazlarindaki teknik gelismelerle ilgili olabilir.
Abstract
Background and aims: In the Endoscopy Unit of Haydarpasa Numune Education and Research Hospital, the endoscopic results of 240 patients who were diagnosed with upper gastrointestinal bleeding were evaluated between February 1, 2007 and May 1, 2008. Materials and methods: These results were compared with results in the same unit obtained over a 15-month period between 1992 and 1993. Results: Of the 240 patients who were evaluated by endoscopy between February 1, 2007 and May 1, 2008, 169 were male, 71 were female, and the median age was 57 (14- 86); 40% were over 60 years old. Of the patients evaluated 15 years ago, the median age was 47.5 (12-84) and 37% were over 60 years old. In the 2008 results, 36.2% of the patients had active bleeding. These patients were endoscopically treated with: injection (82.7%), argon plasma coagulation (12.6%) or heater probe (4.6%). However, in 1993, the ratio of active bleeding was 26%, and these patients were treated by injection only. The most common bleeding cause, duodenal ulcer, significantly decreased (p<0.05). Conclusions: Considering that Helicobacter pylori is the major cause of duodenal ulcer, which is nowadays efficiently treated, a decrease in duodenal ulcer cases could be expected. Another decreasing, though insignificant, cause is variceal bleeding (p>0.05). This decrease may be related to the improvements in the diagnosis and treatment of end-stage chronic liver disease patients. With technical improvements and the expertise of clinicians, lesions that are relatively difficult to diagnose, such as arteriovenous malformations and Dieulafoy’s lesion, are expected to be diagnosed more commonly.
