Therapeutic endoscopic modalities for acute non-variceal upper gastrointestinal bleeding

Abstract

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a relatively common, potentially lifethreatening condition and continues to be one of the most frequent and emergent conditions in everyday clinical practice. Once haemodynamic stability has been achieved, therapeutic endoscopy is vital in control and arrest of bleeding. Peptic ulcer is responsible for more than half of acute UGIB and is the most frequent cause of severe non-variceal bleeding, with duodenal ulcer being far more frequent as compared to stomach ulcer. The introduction of endoscopic hemostasis (endoscopic injection, thermal coagulation, placement of clips or their combination) during the last decades has improved the clinical outcome especially for patients with high-risk stigmata, decreasing the rebleeding rate, blood transfusions requirements, time of hospitalization of patients, the need for urgent surgical haemostasis and probably the mortality rate. METHODS: Records of 102 patients with non variceal UGI bleeding, admitted in Endoscopy Unit of our Clinic (January to December 2011) were retrospectevly analyzed. All of them underwent endoscopic hemostatic treatment. The patients were divided in three groups: gorup A 47 patients received only injection adrenaline; gorup B 42 patients recived adrenaline + sclerosant agent polydocanol , and group C 13 patients treated wih adrenaline + clipsing. Outcome was measured and followed by: rebleeding rate; blood transfusion requirement; duration of hospital stay and the need for urgent surgical haemostasis. RESULTS: The dominant number of patients were males, with male vs. female ratio 3.85:1. Mean age was 54.9. Most common cause of non variceal UGIB were peptic ulcerations ( n=74, 72.5%) , with duodenal ulcer as the most common location (n=46, 62.2%). Only 8/102 (7.84%) patients required urgent surgical hemostasis (group A 5 (10.6%) patients; group B 2 (4.75%) patients and group C 1 (7.7% ) patient). Re bleeding occurs in 9 (19.1%) patinets in group A, 3 (7.15%) patients in grpup B, and in 2 (15.3%) patients in group C. The mean duration of hospitalization was 7.5 days for group A, 5.5 for group B and 5.1 days for group C. Blood transfusion requirement for group A was 1.91 blood units, 1.83 for group B and 1.45 blood units for group C. CONCLUSIONS: Therapeutic endoscopy in acute non-variceal UGIB reduce need for surgery. Combined endoscopic therapy showed supremacy against single therapy, decreasing the rebleeding rate, blood transfusion requirement and duration of hospitalization.