Acute upper gastrointestinal hemorrhage: Is a radiological interventional approach an alternative to emergency surgery?

被引：15
作者：
Langner I. [1 ]
Langner S. [2 ]
Partecke L.I. [1 ]
Glitsch A. [1 ]
Kraft M. [3 ]
Bernstorff W.V. [1 ]
Hosten N. [2 ]
机构：
[1] Department of Surgery, Ernst-Moritz-Arndt-University Greifswald, Greifswald
[2] Institute for Diagnostic Radiology and Neuroradiology, Ernst-Moritz-Arndt-University Greifswald, 17475 Greifswald
[3] Department of Internal Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald
来源：
Emergency Radiology | 2008年 / 15卷 / 6期
关键词：
Gastrointestinal; Hemorrhage; Interventional; Radiography; Surgery;
D O I：
10.1007/s10140-008-0736-z
中图分类号：
学科分类号：
摘要：
The aim of our study was to discuss the option of endovascular treatment compared to surgery for patients with endoscopically unmanageable nonvariceal hemorrhage of the upper gastrointestinal tract. From 2000 to 2006, 23 patients (male, 15 male; female, 8; mean age, 69 years) who failed endoscopic therapy for upper gastrointestinal hemorrhage were retrospectively evaluated. Twelve patients were operated on (SG), whereas 11 patients had an endovascular intervention (IG). Technical and primary clinical success rates and complications rates were calculated. Clinical parameters and comorbidities were related to outcome. The surgical group suffered less frequently from pre-existing pulmonary diseases (SG, 17%; IG, 55%; p=0.05) and had a higher incidence of shock requiring catecholamines (p<0.01) or plasma expander therapy (p<0.01). There was no significant difference in the incidence of recurrent bleeding episodes (SG, 17%; IG, 27%; p=0.35) and mortality rates (SG, 17%; IG, 27%, p=0.35). Deaths in the IG were due to recurrent bleeding. In patients with unsuccessful endoscopic control of nonvariceal bleeding of the upper GI tract, surgery remains a very effective treatment. However, in patients with a high surgical risk due to unknown bleeding sources and/or severe pre-existing diseases/comorbidities, endovascular therapy offers an excellent treatment option. These patients should then be operated on as early as possible to minimize the risk of recurrent bleeding episodes, which are associated with high morbidity and mortality. © 2008 Am Soc Emergency Radiol.
引用
收藏
页码：413 / 419
页数：6
相关论文
共 36 条
  • [1] Rockall T.A., Logan R.F., Devlin H.B., Northfield T.C., Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering committee and members of the national audit of acute upper gastrointestinal haemorrhage, BMJ, 311, pp. 222-226, (1995)
  • [2] Branicki F.J., Coleman S.Y., Fok P.J., Pritchett C.J., Fan S.T., Lai E.C., Mok F.P., Cheung W.L., Lau P.W., Tuen H.H., Et al., Bleeding peptic ulcer: A prospective evaluation of risk factors for rebleeding and mortality, World J Surg, 14, pp. 262-269, (1990)
  • [3] Gilbert D.A., Epidemiology of upper gastrointestinal bleeding, Gastrointest Endosc, 36, (1990)
  • [4] Koelz H.R., Arn M., [New epidemiology of acute gastrointestinal hemorrhage], Chirurg, 77, pp. 103-110, (2006)
  • [5] Shorr R.I., Ray W.A., Daugherty J.R., Griffin M.R., Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease, Arch Intern Med, 153, pp. 1665-1670, (1993)
  • [6] Sonnenberg A., Everhart J.E., The prevalence of self-reported peptic ulcer in the United States, Am J Public Health, 86, pp. 200-205, (1996)
  • [7] Non-variceal upper gastrointestinal haemorrhage: Guidelines, Gut, 51, (2002)
  • [8] Cook D.J., Guyatt G.H., Salena B.J., Laine L.A., Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: A meta-analysis, Gastroenterology, 102, pp. 139-148, (1992)
  • [9] Gabriel S.E., Jaakkimainen L., Bombardier C., Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. a meta-analysis, Ann Intern Med, 115, pp. 787-796, (1991)
  • [10] Graham D.Y., Hepps K.S., Ramirez F.C., Lew G.M., Saeed Z.A., Treatment of Helicobacter pylori reduces the rate of rebleeding in peptic ulcer disease, Scand J Gastroenterol, 28, pp. 939-942, (1993)
1234