Ileo-ileal invagination – a cause of recurrent mid-gastrointestinal bleeding: Diagnostic and endoscopic therapy by means of push-and-pull enteroscopy

2008 ◽  
Vol 40 (6) ◽  
pp. 477-480 ◽  
Author(s):  
A. May ◽  
M. Schoen ◽  
L. Nachbar ◽  
M. Stolte ◽  
C. Ell
Keyword(s):  
Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Push And Pull

scholarly journals Management of acute upper gastrointestinal bleeding

BMJ ◽  
2019 ◽  
pp. l536 ◽  
Author(s):  
Adrian J Stanley ◽  
Loren Laine
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Ulcer Bleeding ◽  
Vasoactive Drugs ◽  
Upper Gastrointestinal

Abstract Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.

scholarly journals Novel hemostatic adhesive powder for nonvariceal upper gastrointestinal bleeding

2019 ◽  
Vol 07 (12) ◽  
pp. E1763-E1767
Author(s):  
Jin-Seok Park ◽  
Hyung Kil Kim ◽  
Yong Woon Shin ◽  
Kye Sook Kwon ◽  
Don Haeng Lee
Keyword(s):  
Gastrointestinal Bleeding ◽  
Success Rate ◽  
Medical Records ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Bleeding Site ◽  
Success Rates ◽  
Main Study ◽  
Rebleeding Rate ◽  
Upper Gastrointestinal

Abstract Background and study aims A new hemostatic adhesive powder (UI-EWD) was developed to reduce high rebleeding rates and technical challenges associated with application of currently available hemostatic powders. The aim of the current study was to assess performance of UI-EWD for nonvariceal upper gastrointestinal bleeding (NVUGIB). Patients and methods A total of 56 consecutive patients that received UI-EWD monotherapy for endoscopic hemostasis due to NVUGIB were retrospectively reviewed. Main study outcomes were success rates with immediate hemostasis and rebleeding within 30 days. Outcomes were analyzed by reviewing patient medical records. Results Etiologies of bleeding were: post-endoscopic therapy bleeding in 46 (82.1 %), peptic ulcer in 8 (14.3 %), tumor in 1 (1.8 %), and other in 1 (1.8 %). UI-EWD was successfully applied at bleeding site in all cases. The success rate of immediate hemostasis was 96.4 % (54/56), and the 30-day rebleeding rate among patients that achieved immediate hemostasis was 3.7 % (2/54). No adverse event related to use of UI-EWD occurred. Conclusion UI-EWD was found to have a high immediate hemostasis success rate in NVUGIB when used as monotherapy and showed promising results in terms of preventing rebleeding.

scholarly journals Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Gut ◽  
2018 ◽  
Vol 67 (10) ◽  
pp. 1757-1768 ◽  
Author(s):  
Joseph JY Sung ◽  
Philip WY Chiu ◽  
Francis K L Chan ◽  
James YW Lau ◽  
Khean-lee Goh ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Working Group ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Asia Pacific ◽  
Endoscopic Management ◽  
Three Stages ◽  
Upper Gastrointestinal

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

scholarly journals Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

2017 ◽  
Vol 05 (05) ◽  
pp. E324-E330 ◽  
Author(s):  
Regina Lamberts ◽  
Anna Koch ◽  
Christian Binner ◽  
Marcus Zachäus ◽  
Ingrid Knigge ◽  
...  
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Anticoagulant Therapy ◽  
Endoscopic Therapy ◽  
High Risk Patient ◽  
Antiplatelet Agents ◽  
High Rate ◽  
Endoscopic Management ◽  
Success Rates ◽  
Primary Hemostasis

Abstract Background and study aims In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding. Success rates with the first endoscopic therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy were analyzed retrospectively. Results Application of the OTSC resulted in immediate hemostasis (primary success rate) in all 75 patients. However, in 34.7 % a rebleeding episode was noted that could be treated by further endoscopic interventions. Only 3 patients had to be sent to the operating room because of failure of endoscopic therapy. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs. 48.9 %). Conclusions Application of the OTSC in GI bleeding results in a high rate of primary hemostasis. Rebleeding occurs in up to 35 % of patients receiving antithrombotic/anticoagulant therapy but can be managed successfully with further endoscopic treatments. Patients in the rebleeding group were more frequently treated with antiplatelet agents. Radiological or surgical therapy was reserved for a small subgroup not successfully managed by repeated endoscopic therapies. OTSC application is the treatment of choice in high-risk patients when conventional clips used as first-line treatment fail.

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