The Korean journal of helicobacter and upper gastrointestinal research (대한상부위장관⦁헬리코박터학회지)

Korean College of Helicobacter and upper Gastrointestinal Reseaarch (대한상부위장관ㆍ헬리코박터학회)
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Endoscopic Hemostatic Treatment of Peptic Ulcer Bleeding

소화성 궤양 출혈의 내시경 치료

  • Choe, Yeon Hwa (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Jun Chul (Department of Internal Medicine, Yonsei University College of Medicine)
  • 최연화 (연세대학교 의과대학 내과학교실) ;
  • 박준철 (연세대학교 의과대학 내과학교실)
  • Received : 2018.05.30
  • Accepted : 2018.07.27
  • Published : 2018.12.31
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Abstract

Peptic ulcer bleeding is a common complication of peptic ulcer disease and the most common cause of upper gastrointestinal bleeding. Despite advances in drug usage and endoscopic modalities, no significant improvement is observed in the mortality rate of bleeding ulcers. The purpose of this review is to discuss various endoscopic hemostatic methods to treat peptic ulcer bleeding. Endoscopic hemostatic techniques can be classified into injection, mechanical, electrocoagulation, hemostatic powder, and endoscopic Doppler-guided hemostatic therapies (the last mentioned being a newly developed technique). Endoscopic hemostasis can be performed as mono or combination therapy using the aforementioned methods. Endoscopic hemostasis is the most important treatment for patients with peptic ulcer bleeding. Endoscopists should consider the treatment approach for peptic ulcer bleeding based on patient characteristics, the size and shape of the lesion, the endoscopist's expertise, and the resources and circumstances at each hospital. Follow-up studies are needed to evaluate the efficacy of newly developed hemostatic powder therapy and endoscopic Doppler-guided hemostasis.

Keywords

References

  1. Kim SG, Kim JG, Shin SK, Kim HS, Seol SY. Guidelines of diagnosis for peptic ulcer disease. Korean J Gastroenterol 2009;54:279-284. https://doi.org/10.4166/kjg.2009.54.5.279
  2. Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet 2009;374:1449-1461. https://doi.org/10.1016/S0140-6736(09)60938-7
  3. Ohmann C, Imhof M, Ruppert C, et al. Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 2005;40:914-920.
  4. Lee MY, Kim JS, Kim BW, et al. Clinical characteristics of peptic ulcer disease in Korea. Korean J Helicobacter Up Gastrointest Res 2014;14:31-38. https://doi.org/10.7704/kjhugr.2014.14.1.31
  5. Rosenstock SJ, Moller MH, Larsson H, et al. Improving quality of care in peptic ulcer bleeding: nationwide cohort study of 13,498 consecutive patients in the Danish Clinical Register of Emergency Surgery. Am J Gastroenterol 2013;108:1449-1457. https://doi.org/10.1038/ajg.2013.162
  6. Spiegel BM, Vakil NB, Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med 2001;161:1393-1404. https://doi.org/10.1001/archinte.161.11.1393
  7. Jang JY. Recent developments in the endoscopic treatment of patients with peptic ulcer bleeding. Clin Endosc 2016;49:417-420. https://doi.org/10.5946/ce.2016.135
  8. Raju GS, Gajula L. Endoclips for GI endoscopy. Gastrointest Endosc 2004;59:267-279. https://doi.org/10.1016/S0016-5107(03)02110-2
  9. Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015;47:a1-46. https://doi.org/10.1055/s-0034-1393172
  10. Lin HJ, Lo WC, Cheng YC, Perng CL. Endoscopic hemoclip versus triclip placement in patients with high-risk peptic ulcer bleeding. Am J Gastroenterol 2007;102:539-543. https://doi.org/10.1111/j.1572-0241.2006.00962.x
  11. Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 2009;7:33-47; quiz 1-2. https://doi.org/10.1016/j.cgh.2008.08.016
  12. Kanwal F, Barkun A, Gralnek IM, et al. Measuring quality of care in patients with nonvariceal upper gastrointestinal hemorrhage: development of an explicit quality indicator set. Am J Gastroenterol 2010;105:1710-1718. https://doi.org/10.1038/ajg.2010.180
  13. Kirschniak A, Kratt T, Stuker D, Braun A, Schurr MO, Konigsrainer A. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc 2007;66:162-167. https://doi.org/10.1016/j.gie.2007.01.034
  14. Chan SM, Chiu PW, Teoh AY, Lau JY. Use of the over-the-scope clip for treatment of refractory upper gastrointestinal bleeding: a case series. Endoscopy 2014;46:428-431. https://doi.org/10.1055/s-0034-1364932
  15. Manta R, Galloro G, Mangiavillano B, et al. Over-the-scope clisp (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg Endosc 2013;27:3162-3164. https://doi.org/10.1007/s00464-013-2871-1
  16. Arima S, Sakata Y, Ogata S, et al. Evaluation of hemostasis with soft coagulation using endoscopic hemostatic forceps in comparison with metallic hemoclips for bleeding gastric ulcers: a prospective, randomized trial. J Gastroenterol 2010;45:501-505. https://doi.org/10.1007/s00535-009-0186-8
  17. Kataoka M, Kawai T, Hayama Y, et al. Comparison of hemostasis using bipolar hemostatic forceps with hemostasis by endoscopic hemoclipping for nonvariceal upper gastrointestinal bleeding in a prospective non-randomized trial. Surg Endosc 2013;27:3035-3038. https://doi.org/10.1007/s00464-013-2860-4
  18. Johanns W, Luis W, Janssen J, Kahl S, Greiner L. Argon plasma coagulation (APC) in gastroenterology: experimental and clinical experiences. Eur J Gastroenterol Hepatol 1997;9:581-587. https://doi.org/10.1097/00042737-199706000-00006
  19. Chau CH, Siu WT, Law BK, et al. Randomized controlled trial comparing epinephrine injection plus heat probe coagulation versus epinephrine injection plus argon plasma coagulation for bleeding peptic ulcers. Gastrointest Endosc 2003;57:455-461. https://doi.org/10.1016/S0016-5107(03)80008-1
  20. Martins BC, Wodak S, Gusmon CC, et al. Argon plasma coagulation for the endoscopic treatment of gastrointestinal tumor bleeding: a retrospective comparison with a non-treated historical cohort. United European Gastroenterol J 2016;4:49-54. https://doi.org/10.1177/2050640615590303
  21. Park JC, Kim YJ, Kim EH, et al. Effectiveness of the polysaccharide hemostatic powder in non-variceal upper gastrointestinal bleeding: using propensity score matching. J Gastroenterol Hepatol 2018;33:1500-1506. https://doi.org/10.1111/jgh.14118
  22. Kim YJ, Park JC, Kim EH, Shin SK, Lee SK, Lee YC. Hemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy. Endosc Int Open 2018;6:E700-E705. https://doi.org/10.1055/a-0593-5884
  23. Sung JJ, Luo D, Wu JC, et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011;43:291-295. https://doi.org/10.1055/s-0030-1256311
  24. Pittayanon R, Rerknimitr R, Barkun A. Prognostic factors affecting outcomes in patients with malignant GI bleeding treated with a novel endoscopically delivered hemostatic powder. Gastrointest Endosc 2018;87:994-1002. https://doi.org/10.1016/j.gie.2017.11.013
  25. Jensen DM, Kovacs TOG, Ohning GV, et al. Doppler endoscopic probe monitoring of blood flow improves risk stratification and outcomes of patients with severe nonvariceal upper gastrointestinal hemorrhage. Gastroenterology 2017;152:1310-1318.e1. https://doi.org/10.1053/j.gastro.2017.01.042
  26. Jensen DM, Ohning GV, Kovacs TO, et al. Doppler endoscopic probe as a guide to risk stratification and definitive hemostasis of peptic ulcer bleeding. Gastrointest Endosc 2016;83:129-136. https://doi.org/10.1016/j.gie.2015.07.012
  27. Law R, Fujii-Lau L, Wong Kee Song LM, et al. Efficacy of endoscopic ultrasound-guided hemostatic interventions for resistant nonvariceal bleeding. Clin Gastroenterol Hepatol 2015;13:808-812.e1. https://doi.org/10.1016/j.cgh.2014.09.030
  28. Barkun A, Sabbah S, Enns R, et al. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol 2004;99:1238-1246. https://doi.org/10.1111/j.1572-0241.2004.30272.x
  29. Lau JY, Barkun A, Fan DM, Kuipers EJ, Yang YS, Chan FK. Challenges in the management of acute peptic ulcer bleeding. Lancet 2013;381:2033-2043. https://doi.org/10.1016/S0140-6736(13)60596-6
  30. Chung IK, Kim EJ, Lee MS, et al. Endoscopic factors predisposing to rebleeding following endoscopic hemostasis in bleeding peptic ulcers. Endoscopy 2001;33:969-975. https://doi.org/10.1055/s-2001-17951
  31. Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974;2:394-397.
  32. Calvet X, Vergara M, Brullet E, Gisbert JP, Campo R. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology 2004;126:441-450. https://doi.org/10.1053/j.gastro.2003.11.006
  33. Marmo R, Rotondano G, Piscopo R, Bianco MA, D'Angella R, Cipolletta L. Dual therapy versus monotherapy in the endoscopic treatment of high-risk bleeding ulcers: a meta-analysis of controlled trials. Am J Gastroenterol 2007;102:279-289; quiz https://doi.org/10.1111/j.1572-0241.2006.01023.x
  34. Vergara M, Bennett C, Calvet X, Gisbert JP. Epinephrine injection versus epinephrine injection and a second endoscopic method in high-risk bleeding ulcers. Cochrane Database Syst Rev 2014;(10):CD005584.
  35. Kim JW, Jang JY, Lee CK, Shim JJ, Chang YW. Comparison of hemostatic forceps with soft coagulation versus argon plasma coagulation for bleeding peptic ulcer--a randomized trial. Endoscopy 2015;47:680-687. https://doi.org/10.1055/s-0034-1391565
  36. Peng YC, Chen SW, Tung CF, Chow WK, Ho SP, Chang CS. Comparison the efficacy of intermediate dose argon plasma coagulation versus hemoclip for upper gastrointestinal non-variceal bleeding. Hepatogastroenterology 2013;60:2004-2010.
  37. Chung IK, Ham JS, Kim HS, Park SH, Lee MH, Kim SJ. Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc 1999;49:13-18. https://doi.org/10.1016/S0016-5107(99)70439-6