Vascular Parenchymal Sources of Upper Gastrointestinal Bleeding

1989 ◽  
Vol 30 (1) ◽  
pp. 39-43 ◽  
Author(s):  
S. Savastano ◽  
G. P. Feltrin ◽  
D. Miotto ◽  
M. Chiesura-Corona ◽  
L. Rubaltelli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Emergency Endoscopy ◽  
Severe Hemorrhage ◽  
Group A ◽  
Group B ◽  
Upper Gastrointestinal ◽  
Selection Of Patients ◽  
Selection Of

Fourteen cases of upper gastrointestinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment.

scholarly journals Safety and Efficacy of the Noncessation Method of Antithrombotic Agents after Emergency Endoscopic Hemostasis in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Daisuke Yamaguchi ◽  
Naoyuki Tominaga ◽  
Koichi Miyahara ◽  
Nanae Tsuruoka ◽  
Yasuhisa Sakata ◽  
...  
Keyword(s):  
Pilot Study ◽  
Propensity Score ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
Antithrombotic Agents ◽  
Safety And Efficacy ◽  
Group A ◽  
Group B ◽  
Upper Gastrointestinal

Background and Aims. The present study aimed to clarify the safety and efficacy of the noncessation method of antithrombotic agents after emergency endoscopic hemostasis in patients with nonvariceal upper gastrointestinal bleeding (UGIB). Methods. In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for nonvariceal UGIB in patients taking antithrombotic agents and resumed the medications without a cessation period (group A). The clinical characteristics, types of antithrombotic agents, UGIB etiology, treatment outcome, and adverse events were evaluated. We used propensity score matching to compare treatment outcomes and adverse events with our previous cohort (group B) in whom antithrombotic agents were transiently discontinued after emergency endoscopic hemostasis. Results. Forty-three consecutive patients were prospectively enrolled. The main antithrombotic agents were low-dose aspirin and direct oral anticoagulants; 11 patients (25.6%) were taking multiple antithrombotics. Peptic ulcers were the main cause of bleeding (95.4%). Endoscopic hemostasis was successful in all patients and the incidence of rebleeding within a month was 7.0%. Propensity score matching created 40 matched pairs. Endoscopic hemostasis was performed by soft coagulation significantly more frequently in group A than in group B (97.5% versus 60.0%, P  < 0.001). Neither the rebleeding rate within a month nor thromboembolic event rate was different between the two groups. However, the mean duration of hospitalization was significantly shorter in group A than in group B (8.6 ± 5.2 d versus 14.4 ± 7.1 d, P  < 0.001). Conclusions. Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for nonvariceal UGIB.

Upper gastrointestinal bleeding and a unique computed tomography scan

Gut ◽  
2008 ◽  
Vol 57 (12) ◽  
pp. 1681-1681
Author(s):  
G S Abi Saad ◽  
K M Musallam ◽  
J Karam ◽  
A Al-Kutoubi ◽  
A N Tawil ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Computed Tomography Scan ◽  
Upper Gastrointestinal ◽  
Tomography Scan

Emergency endoscopy for upper gastrointestinal bleeding in patients with coronary artery disease

2009 ◽  
Vol 27 (7) ◽  
pp. 802-809 ◽  
Author(s):  
Ping-Huei Tseng ◽  
Jyh-Ming Liou ◽  
Yi-Chia Lee ◽  
Lian-Yu Lin ◽  
Alyssa Yan-Zhen Liu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Emergency Endoscopy ◽  
Artery Disease ◽  
Upper Gastrointestinal

scholarly journals Clinical and endoscopic features of aorto-duodenal fistula resulting in definitive diagnosis: an observational study

2020 ◽  
Author(s):  
Chikamasa Ichita ◽  
Akiko Sasaki ◽  
Chihiro Sumida ◽  
Karen Kimura ◽  
Takashi Nishino ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Vital Signs ◽  
Diagnostic Methods ◽  
Upper Endoscopy ◽  
Duodenal Fistula ◽  
Endoscopic Characteristics ◽  
Upper Gastrointestinal

Abstract Background: An aorto-duodenal fistula presents with upper gastrointestinal bleeding and hematemesis. Early diagnosis is difficult, and the disease is associated with high mortality. Sometimes, a small amount of bleeding, known as herald bleed, occurs repeatedly and may be judged as upper gastrointestinal bleeding, prompting emergency upper endoscopy. Diagnostic methods and surgical treatment during herald bleeding are important for saving lives. However, most fistulas form in the horizontal duodenum, and active bleeding is rarely found in patients with herald bleeding. Moreover, an aorto-duodenal fistula is rarely diagnosed based on upper endoscopy alone. Methods: The present study examined the clinical and endoscopic characteristics of aorto-duodenal fistula in eight patients who underwent upper endoscopy before diagnosis at our hospital. It also sought to clarify how aorto-duodenal fistula can be appropriately diagnosed. Results: All patients had a history of aortic treatment, and many could not be diagnosed by computed tomography scan or upper endoscopy alone. Regarding the endoscopic findings, patients were seen to have stent/vascular prosthesis exposure, which is diagnostic of aorto-duodenal fistula as well as pulsatile lesions and massive fresh bleeding of obscure origin in the duodenum. Conclusions: If the diagnosis is unclear, clinicians may need to observe the horizontal duodenum using a fitted tip attachment or long scope. Since vital signs may fluctuate during endoscopy, a series of tests should be performed immediately. Proactive placement of marking clips in likely areas of the fistula may facilitate diagnosis via computed tomography. The present results demonstrate that proper diagnosis and prompt surgical treatment save lives in patients with aorto-duodenal fistula.

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