Endoscopic Management of Lower Gastrointestinal Hemorrhage

2019 ◽  
Author(s):  
Rebecca Kosowicz ◽  
Lisa L. Strate
Keyword(s):  
High Risk ◽  
Diagnostic Yield ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Endoscopic Management ◽  
Optimal Timing ◽  
Severe Bleeding ◽  
Diverticular Bleeding ◽  
Lower Gastrointestinal Hemorrhage ◽  
Vascular Ectasias

Lower gastrointestinal bleeding (LGIB) is a common gastrointestinal emergency. Colonoscopy is the initial diagnostic and therapeutic procedure for most patients with LGIB. The optimal timing of colonoscopy is uncertain, but earlier examinations are associated with higher diagnostic yield. In patients with severe bleeding, colonoscopy should be performed within 24 hours of presentation after an adequate orally administered colon preparation. Additional washing during colonoscopy and careful inspection should be performed to identify high-risk stigmata. Endoscopic therapy should be attempted if high-risk bleeding stigmata are identified. The endoscopic treatment modality depends on the bleeding source, location, operator expertise, and the need for ongoing anticoagulation or antiplatelet therapy. This review 5 tables, 5 figures, and 50 references. Keywords: argon plasma coagulation, clipping, colonoscopy, diverticular bleeding, endoscopic band ligation, endoscopic hemostasis, postpolypectomy bleeding, stigmata of recent hemorrhage, vascular ectasias

Endoscopic Management of Lower Gastrointestinal Hemorrhage

2019 ◽  
Author(s):  
Rebecca Kosowicz ◽  
Lisa L. Strate
Keyword(s):  
High Risk ◽  
Diagnostic Yield ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Endoscopic Management ◽  
Optimal Timing ◽  
Severe Bleeding ◽  
Diverticular Bleeding ◽  
Lower Gastrointestinal Hemorrhage ◽  
Vascular Ectasias

Lower gastrointestinal bleeding (LGIB) is a common gastrointestinal emergency. Colonoscopy is the initial diagnostic and therapeutic procedure for most patients with LGIB. The optimal timing of colonoscopy is uncertain, but earlier examinations are associated with higher diagnostic yield. In patients with severe bleeding, colonoscopy should be performed within 24 hours of presentation after an adequate orally administered colon preparation. Additional washing during colonoscopy and careful inspection should be performed to identify high-risk stigmata. Endoscopic therapy should be attempted if high-risk bleeding stigmata are identified. The endoscopic treatment modality depends on the bleeding source, location, operator expertise, and the need for ongoing anticoagulation or antiplatelet therapy. This review 5 tables, 5 figures, and 50 references. Keywords: argon plasma coagulation, clipping, colonoscopy, diverticular bleeding, endoscopic band ligation, endoscopic hemostasis, postpolypectomy bleeding, stigmata of recent hemorrhage, vascular ectasias

scholarly journals Adrenaline Injection Plus Argon Plasma Coagulation versus Adrenaline Injection Plus Hemoclips for Treating High-Risk Bleeding Peptic Ulcers: A Prospective, Randomized Trial

2009 ◽  
Vol 23 (10) ◽  
pp. 699-704 ◽  
Author(s):  
Seyed Alireza Taghavi ◽  
Seyed Mohammad Soleimani ◽  
Seyed Mohammad Kazem Hosseini-Asl ◽  
Ahad Eshraghian ◽  
Hajar Eghbali ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Trial ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Prospective Randomized Trial ◽  
Peptic Ulcers ◽  
Plasma Coagulation ◽  
End Point ◽  
Bleeding Peptic Ulcers ◽  
Adrenaline Injection

BACKGROUND/OBJECTIVE: Several combination endoscopic therapies are currently in use. The present study aimed to compare argon plasma coagulation (APC) + adrenaline injection (AI) with hemoclips + AI for the treatment of high-risk bleeding peptic ulcers.METHODS: In a prospective randomized trial, 172 patients with major stigmata of peptic ulcer bleeding were randomly assigned to receive APC + AI (n=89) or hemoclips + AI (n=83). In the event of rebleeding, the initial modality was used again. Patients in whom treatment or retreatment was unsuccessful underwent emergency surgery. The primary end point of rebleeding rate and secondary end points of initial and definitive hemostasis need for surgery and mortality were compared between the two groups.RESULTS: The two groups were similar in all background variables. Definitive hemostasis was achieved in 85 of 89 (95.5%) of the APC + AI and 82 of 83 (98.8%) of the hemoclips + AI group (P=0.206). The mean volume of adrenaline injected in the two groups was equal (20.7 mL; P=0.996). There was no significant difference in terms of initial hemostasis (96.6% versus 98.8%; P=0.337), rate of rebleeding (11.2% versus 4.8%; P=0.124), need for surgery (4.5% versus 1.2%; P=0.266) and mortality (2.2% versus 1.2%; P=0.526). When compared for the combined end point of mortality plus rebleeding and the need for surgery, there was an advantage for the hemoclip group (6% versus 15.7%, P=0.042).CONCLUSION: Hemoclips + AI has no superiority over APC + AI in treating patients with high-risk bleeding peptic ulcers. Hemoclips + AI may be superior when a combination of all negative outcomes is considered.

scholarly journals Endoscopic Management of Postlaparoscopic Sleeve Gastrectomy Leaks: A Single-Center Experience

2020 ◽  
Vol 11 (02) ◽  
pp. 134-137
Author(s):  
Nitin Jagtap ◽  
H.S. Yashavanth ◽  
Rakesh Kalapala ◽  
Abhishek Katakwar ◽  
Mohan Ramchandani ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Argon Plasma Coagulation ◽  
Gastroesophageal Junction ◽  
Argon Plasma ◽  
Endoscopic Management ◽  
Metal Stents ◽  
Primary Therapy ◽  
Sems Placement ◽  
Preoperative Body Mass Index ◽  
Distal Migration

Abstract Introduction Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery. Sleeve leak is the most important complication, with an incidence of 1.9 to 2.4%. Various endoscopic approaches to LSG have been used, including self-expanding metal stents (SEMSs), glue injection, and clipping along with percutaneous drainage. This study was aimed to study the role of endotherapy in the management of post-LSG leaks. Methods This study included patients referred for endotherapy for post-LSG leak between January 2016 and December 2018. We maintained data prospectively, which included the location and type of leak, type of endotherapy, adverse events, and time for leak closure. Primary endotherapy included mega SEMS placement; if it failed, then secondary endoscopic therapy was performed. Results Seven patients (four females, with a mean age of 45.2 years) with a preoperative body mass index of mean 38.5 kg/m2 underwent endotherapy for post-LSG leaks. Two were acute, four were early, and the remaining one was late leak. Five were located proximally near gastroesophageal junction and two at the midsleeve level. In four (57.1%) patients, the leak was resolved by primary therapy. Three patients underwent secondary therapy that included overlapping SEMS placement (in one patient), SEMS replacement (in one patient), and short plastic biliary stent placement with Argon plasma coagulation (APC) to create a raw surface and induce granulation tissue. The median duration for leak closure was 12 weeks (range: 8–24 weeks). One patient who had partial distal migration underwent overlapping SEMS placement. Three patients had nonbleeding ulcers at the distal end of SEMS at removal. Conclusion Endotherapy is effective and safe for the management of post-LSG leaks. Additional endotherapy can be used if primary therapy is not successful for resolution of the leak.

scholarly journals Endoscopic treatment for chronic radiation proctitis

2020 ◽  
Vol 10 (3-4) ◽  
pp. 65-72
Author(s):  
E. A. Grishina ◽  
K. V. Shishin ◽  
I. Yu. Nedoluzhko ◽  
N. A. Kurushkina ◽  
L. V. Shumkina ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
High Risk ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Radiation Proctitis ◽  
Bipolar Coagulation ◽  
Endoscopic Techniques ◽  
Plasma Coagulation ◽  
Chronic Radiation Proctitis ◽  
Chronic Radiation

The preferred method in detection and staging of chronic radiation proctitis is colonoscopy. Moreover, endoscopy is used widely in treating patients with this disease. The main goal of endoscopic techniques is hemostasis and elimination of vascular transformations. This includes formalin application, band ligation, various types of laser irradiation, bipolar coagulation and cryotherapy. However, these methods are associated with relatively high risk of complications, whereas argon plasma coagulation and radiofrequency ablation are effective, relatively safe techniques for chronic radiation proctitis and well tolerated by patients.

scholarly journals Comparison of Hemostatic Efficacy of Argon Plasma Coagulation with and without Distilled Water Injection in Treating High-Risk Bleeding Ulcers

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Yuan-Rung Li ◽  
Ping-I Hsu ◽  
Huay-Min Wang ◽  
Hoi-Hung Chan ◽  
Kai-Ming Wang ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Stay ◽  
Combined Therapy ◽  
Argon Plasma Coagulation ◽  
Water Injection ◽  
Argon Plasma ◽  
Distilled Water ◽  
Plasma Coagulation ◽  
Hemostatic Efficacy ◽  
Bleeding Ulcers

Background. Argon plasma coagulation (APC) is useful to treat upper gastrointestinal bleeding, but its hemostatic efficacy has received little attention.Aims. This investigation attempted to determine whether additional endoscopic injection before APC could improve hemostatic efficacy in treating high-risk bleeding ulcers.Methods. From January 2007 to April 2011, adult patients with high-risk bleeding ulcers were included. This investigation compared APC plus distilled water injection (combined group) to APC alone for treating high-risk bleeding ulcers. Outcomes were assessed based on initial hemostasis, surgery, blood transfusion, hospital stay, rebleeding, and mortality at 30 days posttreatment.Results. Totally 120 selected patients were analyzed. Initial hemostasis was accomplished in 59 patients treated with combined therapy and 57 patients treated with APC alone. No significant differences were noted between these groups in recurred bleeding, emergency surgery, 30-day mortality, hospital stay, or transfusion requirements. Comparing the combined end point of mortality plus the failure of initial hemostasis, rebleeding, and the need for surgery revealed an advantage for the combined group(P=0.040).Conclusions. Endoscopic therapy with APC plus distilled water injection was no more effective than APC alone in treating high-risk bleeding ulcers, whereas combined therapy was potentially superior for patients with poor overall outcomes.

Hyperplastic Polyps Following Argon Plasma Coagulation of Gastric Antral Vascular Ectasias

2014 ◽  
Vol 109 ◽  
pp. S622
Author(s):  
Yana Cavanagh ◽  
Nihar Shah ◽  
Allison Thomas ◽  
Walid Baddoura ◽  
Sohail Shaikh
Keyword(s):  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Hyperplastic Polyps ◽  
Plasma Coagulation ◽  
Vascular Ectasias
Sign in / Sign up

Export Citation Format

Share Document