Nisan 2014
Varis disi üst GIS kanamali hastalarda endoskopik klip uygulamalarimiz
Endoscopic clipping for non-variceal upper gastrointestinal bleeding
- Ana Sayfa
- Sayılar
- Nisan 2014
- Varis disi üst GIS kanamali hastalarda endoskopik klip uygulamalarimiz
...
Atatürk Egitim ve Arastirma Hastanesi, 2 Gastroenteroloji Klinigi, Ankara
Özet
Giris ve Amaç:Endoskopik klip uygulamasi üst gastrointestinal sistem kanamasi tedavisinde yaygin olarak kullanilmaktadir. Kanayan peptik ülser, Dieulafoy lezyonu ve Mallory-Weiss yirtiginda klip ile kanama kontrolünün saglanabilecegi gösterilmistir. Biz bu çalismada klinigimizin üst gastrointestinal sistem kanamasinda endoskopik klip uygulama verilerini degerlendirdik. Gereç ve Yöntem:Üst gastrointestinal sistem kanamasi nedeniyle yatirilan ve endoskopik klip uygulanan 27 hasta retrospektif olarak incelendi. Klip uygulama nedenleri, tekrar kanama sikligi, eritrosit süspansiyon ihtiyaçlari, mortalite sikligi, Rockall skoru ve Glasgow-Blatchford skoru degerlendirildi. Bulgular:Çalismaya dahil edilen hastalarin 17’si erkek, 10’u kadin idi ve yas ortalamasi 58,7 yil olarak hesaplandi. Klip uygulanan 5 hastada gastrik ülser (1 hasta Forrest 1a, 2 hasta Forrest 1b, 2 hasta Forrest 2a); 10 hastada duodenal ülser (5 hasta Forrest 1b, 5 hasta Forrest 2a); 7 hastada Mallory-Weiss yirtigi ve 4 hastada Dieulafoy lezyonu üst gastrointestinal sistem kanamasinin nedeni idi. Hastalardan birinde ise hem Forrest 2a duodenum ülseri hem de Mallory-Weiss yirtigi mevcuttu. 27 hastanin 2’sinde (%7,4) islem sonrasi takip sirasinda kanama tekrarladi. Hastalarin 19’unda (%70) eritrosit süspansyonu ihtiyaci oldu ve toplam 72 ünite ES verildi. Hastalarin ortalama Rockall skoru 2,9 ve ortalama Glasgow-Blatchford skoru 8,5 idi. Sonuç:Prognoz açisindan riskli olan hastalarimizda mortalite saptanmamis ve tekrar kanama riski düsük bulunmustur.
Abstract
Background and Aims: Endoscopic clipping has been widely used for upper gastrointestinal bleeding. It has been shown that hemostasis with endoscopic clipping is successful in bleeding peptic ulcers, Dieulafoy’s lesions, and Mallory-Weiss tears. The aim of this study was to evaluate the efficacy of endoscopic clipping in our endoscopy unit. Materials and Methods: Patients presenting with upper gastrointestinal bleeding were evaluated retrospectively. Twenty-seven patients were treated with endoscopic clipping. The etiology of bleeding, rebleeding rates, need for packed red blood cell transfusion, mortality rate, and the Rockall and Glasgow-Blatchford scores were noted. Results:The mean age of the patients (17 male, 10 female) was 58,7 years. Five patients had gastric ulcer (1 Forrest 1a, 2 Forrest 1b, 2 Forrest 2a), 10 patients duodenal ulcer (5 Forrest 1b, 5 Forrest 2a), 7 patients MalloryWeiss tears, and 4 patients Dieulafoy’s lesion as the etiology of upper gastrointestinal bleeding. One patient had Forrest 2a duodenal ulcer and Mallory-Weiss tears. Two of the patients (7,4%) rebled. Nineteen patients needed packed red blood cell transfusion with a total of 72 units. The mean Rockall score was 2,9 and the mean Glasgow-Blatchford score was 8,5. Conclusions:Although our patient population was high-risk, the rebleeding rate was low, and none of the patients died.
