Nisan 2013
Varis disi üst gastrointestinal sistem kanamasinda endoskopik tedavinin basarisi ve tekrar kanama oranlari
Endoscopic treatment success and rebleeding rates in non-variceal upper GI bleeding
- Ana Sayfa
- Sayılar
- Nisan 2013
- Varis disi üst gastrointestinal sistem kanamasinda endoskopik tedavinin basarisi ve tekrar kanama oranlari...
Özet
Giris ve Amaç:Varis disi üst gastrointestinal sistem kanamalarinda endoskopik tedaviler arasinda injeksiyon tedavisi, termal koagülasyon metodlari, argon plazma koagülasyon ve endoskopik klip uygulamasi sayilabilir. Bu çalismada endoskopik tedavi yöntemleri ile tekrar kanama arasindaki iliski arastirildi. Gereç ve Yöntem:Çalismaya bir yillik süre içerisinde Gaziantep Üniversitesi Tip Fakültesi Gastroenteroloji Bilim Dali Endoskopi Ünitesi’nde üst gastrointestinal sistem kanama nedeni ile endoskopi yapilan hastalar alindi. Bulgular: Toplam 5451 hastanin 305 tanesinde üst gastrointestinal sistem kanama ön tanisi ile endoskopi yapildi. Bu hastalarin 68 adedinde (%22,2) varis disi kanama tespit edildi. Bu hastalarin 38 tanesinde (%55,8) duodenal ülser, 23’ünde (%33,8) gastrik ülser, 7’sinde (%10,2) eroziv gastropati-bulbopati nedenli kanama izlendi. Duodenal ülserli hstalarin 28’inde (%73,6) ve gastrik ülserli hastalarin 13’ünde (%56,5) sadece injeksiyon tedavisi, her iki grupta 10’ar hastada (%26,3/%43,4) kombine tedavi (injeksiyon tedavisi+termal koagülasyon; injeksiyon tedavisi+argon plazma koagülasyon) uygulandi. Tekrar kanama; monoterapi uygulanan hastalarin yine sirasiyla 4/1’inde (%14,2/%7,6); kombine tedavi yapilanlarin ise sirasiyla 0/2’sinde (%0/%20 ) tespit edildi. Sonuç:Varis disi üst gastrointestinal sistem kanamalarinda, özellikle duodenal ülser varliginda kombine tedavi seçeneklerinin tercih edilmesi gerektigi kanaatindeyiz.
Abstract
Background and Aims: Upper gastrointestinal system bleeding is an important and sometimes mortal situation. For endoscopic treatment of non-variceal upper gastrointestinal bleeding, some methods, such as injection treatment, thermal coagulation, argon plasma coagulation, and endoscopic clipping, can be used. In this study, we evaluated the relation between the endoscopic treatment modality for upper gastrointestinal bleeding and the re-bleeding rates. Materials and Methods: Patients who underwent gastrointestinal endoscopy for bleeding over a one-year period were included in the study. Results: We performed upper gastrointestinal endoscopy in a total of 5451 patients, and endoscopy was performed for upper gastrointestinal bleeding in 305 of them. In 68 of 305 patients (22.2%), there was active non-variceal bleeding. Among those patients, 38 of 68 (55.8%) had duodenal ulcer, 23 (33.8%) gastric ulcer, and 7 (10.2%) erosive gastrobulbopathy. Twenty-eight of 38 duodenal ulcer patients (73.6%) and 13 of 23 gastric ulcer patients (56.5%) had only injection treatment. Ten patients in each group (duodenal/gastric ulcer; 26.3% and 43.4%, respectively) received combined endoscopic therapy (injection treatment + thermal coagulation or injection treatment + argon plasma coagulation). In the monotherapy group, re-bleeding occurred in 4 of 28 duodenal ulcer patients (14.2%) and in 1 of 13 gastric ulcer patients (7.6%). In the combined therapy group, there was no re-bleeding in duodenal ulcer patients, but re-bleeding occurred in 2 of 10 patients (20%) with gastric ulcer. Conclusions:We believe that combined endoscopic therapy for upper gastrointestinal bleeding is more effective than monotherapy, especially in duodenal ulcer.
