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Endoscopic injection therapy for non-variceal upper gastrointestinal bleeding at Auckland Hospital
Ravinder Ogra1, Mark Lane, Phillip Wong
1Auckland Hospital. Rogra@middlemore.co.nz
Insights
Endoscopic injection therapy effectively stops non-variceal upper gastrointestinal bleeding, achieving high initial success rates. Repeat injections are also successful for patients who rebleed, demonstrating its value as a first-line treatment.
Area of Science:
- Gastroenterology
- Endoscopic procedures
- Hemorrhage management
Background:
- Non-variceal upper gastrointestinal bleeding is a common clinical challenge.
- Endoscopic therapies are crucial for managing acute bleeding events.
Purpose of the Study:
- To audit the efficacy of endoscopic injection therapy for non-variceal upper GI bleeding.
- To evaluate adrenaline injection as a first-line treatment.
Main Methods:
- Retrospective review of 183 patient records.
- Analysis of endoscopic injection therapy outcomes for upper GI bleeding.
Main Results:
- Achieved primary hemostasis in 96.7% of patients.
- Overall rebleeding rate was 18.6%, with higher rates for spurting vessels (36.8%).
- Repeat injections were successful in all treated patients.
Conclusions:
- Endoscopic injection therapy is an effective, simple, and cost-efficient first-line treatment.
- Repeat endoscopic injections are effective for managing rebleeding.
- Adrenaline injection therapy demonstrates significant success in controlling non-variceal upper GI bleeding.
Aim:
The aim of this study was to audit the efficacy of endoscopic injection therapy for non-variceal upper gastrointestinal (GI) bleeding at Auckland Hospital.
Methods:
The medical records of 183 patients who had undergone endoscopic injection of adrenaline for non-variceal upper GI bleeding at Auckland Hospital between November 1996 and May 1999 were reviewed.
Results:
Primary haemostasis was achieved in 177 (96.7%) patients and six (3.3%) patients had early surgery due to failure of injection therapy. The overall rate of rebleeding was 18.6%. The rate of rebleeding according to the stigmata seen at the time of endoscopy was 36.8% for patients showing spurting vessel; 24% for active ooze; 18.2% for visible vessel; and 3.2% for adherent clot. Active spurting vessels seen on endoscopy were associated with higher risk of repeat injection (p <0.01) and death (p <0.001). Sixteen (9%) patients had repeat injection. Haemostasis was achieved in all, and no deaths or surgical interventions were observed in this subgroup.
Conclusions:
Endoscopic injection therapy is an effective, simple and cheap first-line therapy for non-variceal upper GI bleeding. The repeat injection also appears to be an effective treatment for patients rebleeding after the initial injection therapy.
