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Endoscopic sclerosis in the treatment of bleeding peptic ulcers with a visible vessel
1Service of Gastroenterology, Hospital Mutua de Terrassa, Barcelona, Spain.
Insights
Endoscopic sclerosis effectively treated bleeding ulcers with visible vessels in 90% of patients. This minimally invasive procedure offers a primary treatment option for managing ulcer hemorrhage.
Area of Science:
- Gastroenterology
- Endoscopic interventions
- Gastrointestinal bleeding
Background:
- Bleeding peptic ulcers with visible vessels pose a significant clinical challenge.
- Endoscopic interventions are crucial for managing upper gastrointestinal hemorrhage.
- The efficacy of endoscopic sclerosis in routine clinical practice requires evaluation.
Purpose of the Study:
- To assess the efficacy of endoscopic sclerosis in patients with bleeding ulcers.
- To determine the success rate of endoscopic sclerosis in achieving hemostasis.
- To evaluate the role of endoscopic sclerosis in the management of visible vessels in ulcers.
Main Methods:
- A prospective study involving 53 patients with visible vessels in ulcers over 14 months.
- Endoscopic sclerosis performed using adrenaline and polidocanol.
- Fifty patients underwent the procedure; 18 had actively bleeding vessels, 32 had non-bleeding visible vessels.
Main Results:
- Permanent hemostasis was achieved in 45 patients (90%).
- 62% achieved hemostasis with one session, and 28% with two sessions.
- Five patients experienced rebleeding requiring emergency surgery.
Conclusions:
- Endoscopic sclerosis is a highly effective primary treatment for bleeding ulcers with visible vessels.
- The procedure demonstrates a high success rate in achieving permanent hemostasis.
- It plays a crucial role in the routine clinical management of such gastrointestinal bleeding.
Abstract:
We have assessed the efficacy of endoscopic sclerosis in the routine clinical management of patients with bleeding ulcers, in whom a visible vessel was identified at endoscopy. Over a period of 14 months, a visible vessel at the base of an ulcer was identified in 53 patients. Three patients could not undergo sclerosis, one because of torrential bleeding and two because of ulcer location. Fifty patients, 18 with a bleeding vessel and 32 with a nonbleeding vessel, were subjected to endoscopic sclerosis with adrenaline plus polidocanol. Permanent hemostasis was achieved in 45 patients (90%), 31 (62%) cases with one session and 14 (28%) cases with two sessions of sclerosis. Four patients had persistent rebleeding in spite of two sessions of sclerosis, and one patient had a massive rebleeding after the first session; all underwent emergency surgery. We believe that endoscopic sclerosis has a primary role in the treatment of ulcer bleeding, particularly in those patients in whom a visible vessel is identified at endoscopy.