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Efficiency of primary and repeated endoscopic hemostasis in non-variceal upper gastrointestinal bleedin


Author: Dolghii Andrei
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2008
Scientific adviser: Gheorghe Ghidirim
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 10 September, 2008
Approved by NCAA on the 23 October, 2008

Abstract

Adobe PDF document0.63 Mb / in romanian

Thesis

CZU 616.34-005.1-072.1

Adobe PDF document 3.98 Mb / in romanian
158 pages


Keywords

Non-variceal bleeding – endoscopic hemostasis – rebleeding – human thrombin – hemoclipse –metallic microparticles – adherent clot

Summary

The aim of the study was to improve the treatment results of the patients with non-variceal upper gastrointestinal bleeding based on rational application of endoscopic haemostatic methods. Study is based on the data of durable prospective investigation, which are analyzed endoscopic treatment results of 955 consecutive patients with upper gastrointestinal hemorrhage. As a source of bleeding are served: acute gastroduodenal ulcers – 60 (6,28%), Mallory-Weiss tears – 106 (11,10%), Dieulafoy’s lesion – 13 (1,36%), chronic gastric ulcer – 169 (17,70%), chronic duodenal ulcer – 568 (59,48%), and marginal ulcer – 39 (4,08%) cases. There were estimated results of routine use of endoscopic therapy in the large group of consecutive patients with non-variceal upper gastrointestinal bleeding, not limited by certain diagnosis, rigid including criteria, elected endoscopic hemostasis method, or applied hemostatic agent. Optimal indications for endoscopic therapy, aim of which is stopping of active bleeding and reduce the risk of rebleeding, should be established within careful visual assessment of stigmata in the source of bleeding. The main factors associated with failure of endoscopic hemostasis include morphological features of non-variceal upper gastrointestinal hemorrhage source: spurting bleeding Forrest IA, major caliber and great blood flow in responsible artery, as well as large size and depth of bleeding defect, and its location on posterior bulb wall or high in the gastric body. Have been proved, that efficacy of selected hemostatic methods is differ significantly, depending on appropriate clinical situation and may be limited by etiology of upper gastrointestinal bleeding, stigmata of hemorrhage, situation of bleeding point, risk of complications, and decreased portability and imperfection of equipment. In clinical conditions have been defined efficacy, safety, indications and limitations of the new endoscopic hemostatic method, based on introduction of metallic microparticles into the floor of the gastroduodenal ulcer with recent hemorrhage. The injections of human thrombin are proved to be universal and high-effective method of primary and repeated endoscopic hemostasis, independent on etiology and characteristics of upper gastrointestinal bleeding, while its application does not associated with significant influence upon blood coagulation system and another complications. Have been shown, that endoscopic retreatment for rebleeding is effective alternative to surgical intervention, especially in patients with hemodynamically insignificant rebleeding, hemorrhage from acute lesions and high operative risk. Have been motivated indications for repeated programmed second-look endoscopy, and elaborated technical features of “difficult” endoscopic hemostasis.