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PubMed2001

Risk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: a register-based cohort study.

PURPOSE: We assessed the risk of hospitalization for upper gastrointestinal bleeding among patients using systemic corticosteroids, accounting for the use of other drugs that may increase the risk of bleeding. SUBJECTS AND METHODS: We conducted a population-based cohort study in North Jutland County, Denmark. Data on the use of corticosteroids, nonsteroidal anti-inflammatory drugs, aspirin, and anticoagulants during 1991 to 1995 were obtained from a countywide prescription database. All hospitalizations because of upper gastrointestinal bleeding were identified through the Hospital Discharge Registry. The observed numbers of patients with gastrointestinal bleeding in various exposure categories among corticosteroid users were compared with the expected number based on the North Jutland population who did not receive prescriptions for any of the drugs under study. RESULTS: A total of 45,980 patients accrued 18,379 person-years of corticosteroid use. There were 109 hospital admissions for gastrointestinal bleeding among corticosteroid users, compared with 26 expected, yielding a relative risk of 4.2 [95% confidence interval (CI): 3.4 to 5.0]. Among corticosteroid users who did not use other drugs associated with gastrointestinal bleeding, the relative risk was 2.9 (95% CI: 2.2 to 3.7). The relative risk decreased further to 1.9 (95% CI: 1.4 to 2.5) when current corticosteroid usage was compared with former usage. CONCLUSION: We observed an increased risk of hospitalization because of upper gastrointestinal bleeding among patients prescribed corticosteroids, especially among those who use other medications. Confounding from the underlying disease may also have contributed to the observed increase in risk.

Adolescent↗
PubMed1998

Second-trimester vaginal bleeding: correlation of ultrasonographic findings with perinatal outcome.

OBJECTIVE: Our purpose was to determine the relationship between ultrasonographic findings and perinatal outcome in patients with second-trimester vaginal bleeding. STUDY DESIGN: A retrospective case-control study was performed. One hundred sixty-seven patients with ultrasonographic examinations performed for bleeding between 13 and 26 weeks' gestation were identified through a comprehensive ultrasonography database. The main ultrasonographic findings of interest were the presence of an intrauterine clot, membrane separation, and placenta previa. A control group of 167 patients was obtained by selecting the next consecutive patient from the comprehensive perinatal database. Perinatal outcome measures for both groups were recorded. RESULTS: Multiparity was more common in patients with bleeding than in controls (69% vs 58%, p = 0.036), as was history of two or more previous preterm deliveries (6% vs none, p = 0.005). Second-trimester vaginal bleeding was associated with increased risk of preterm delivery (relative risk 1.9, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 6.3, 95% confidence interval 1.9 to 2.1), and perinatal death (relative risk 5.4, 95% confidence interval 2.1 to 13.7). The perinatal mortality rate was 162:1000 in these patients versus 30:1000 in controls. To assess the impact of ultrasonographic abnormalities, the study group was divided into two groups. Among the patients with second-trimester vaginal bleeding those with abnormal ultrasonographic findings had an increased risk of preterm delivery (relative risk 2.0, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 2.6, 95% confidence interval 1.1 to 6.3), perinatal death (relative risk 2.6, 95% confidence interval 1.3 to 5.3), and neonatal intensive care unit admissions (relative risk 3.2, 95% confidence interval 1.6 to 6.1). The perinatal mortality rate was 258:1000 for patients with abnormal ultrasonographic examinations. CONCLUSION: Second-trimester vaginal bleeding is more common in multiparous women and in women with a history of a previous preterm delivery. Perinatal morbidity and mortality is increased in patients with bleeding during the second trimester. The risk is compounded when abnormalities are detected by ultrasonography.

Adult↗
PubMed1999

Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen.

BACKGROUND: Angiographic embolization is an effective technique to control bleeding after blunt trauma to the liver or pelvis. Its role in penetrating trauma to the abdomen has not been studied. METHODS: From January 1992 to May 1998, 40 patients underwent angiography for bleeding resulting from intra-abdominal penetrating injuries (33 gunshot wounds, 7 stab wounds). Angiographic embolization of intraperitoneal or retroperitoneal vessels was performed by standard angiographic techniques with gelatin sponge and/or coils. Data were extracted from medical records, radiology data bank, trauma registry, and morbidity/mortality records, and compared by Student's t test and chi-square test. The main outcome measures were failure of angiographic embolization to control bleeding and complications of angiographic embolization. RESULTS: Angiography was performed during a course of nonoperative management in 6 patients (group A), because of failure to control bleeding surgically in 23 (group B), and because of late vascular complications after an initially successful operation in 11 more (group C). In 32 patients, angiography revealed active bleeding; 29 (91 %) underwent successful angiographic embolization. Of the remaining 3 patients, 2 were successfully managed surgically (1 each from groups A and B) and 1 died despite multiple surgical maneuvers (group B). One patient who developed postoperatively a large, bleeding superior mesenteric artery pseudoaneurysm, suffered extensive bowel necrosis after angiographic embolization. No other significant complication was related to angiographic embolization. CONCLUSIONS: Angiographic embolization after penetrating injuries to the abdomen is safe and effective for a small number of selected patients. It is a valuable tool for bleeding control when surgery has failed. It may be ideal for control of late vascular complications when reoperation is not desirable. It may prove to be a useful adjunct in the nonoperative treatment of selected injuries.

Abdominal Injuries↗
PubMed1980

Positive end-expiratory pressure in the management of the patient with a postoperative bleeding heart.

This prospective study involves 406 consecutive adults who had heart operation with extracorporeal circulation. Fifteen patients (3.7%) bled at the rate of 200 ml per hour or more in the postoperative period. Thirteen of the 15 patients who bled had undergone coronary artery operation. After all clotting factors and, when applicable, hypertension had been checked and corrected, positive end-expiratory pressure (PEEP) was used in managing the bleeding of these patients. Before institution of PEEP, the average bleeding was 330 ml per hour for one to five hours. After PEEP was instituted in the 11 patients in whom bleeding was controlled, an average output of 25 ml per hour for one to ten hours was recorded. Patients were kept on PEEP for 5 to ten hours. In 7 patients hemorrhage was controlled with 10 cm H2O of PEEP; 4 required 15 cm of PEEP to stop bleeding; 3 were explored for continuous bleeding on 15 cm of PEEP; and 1 was explored because of hypotension on 15 cm of PEEP. In 11 of the 15 patients who bled postoperatively (73%), operation was avoided by judicious use of PEEP. We believe that PEEP increases mediastinal pressure and that the overdistended lung can obliterate some bleeding in the mediastinum, thus controlling bleeding in many of these patients.

Cardiac Surgical Procedures↗
PubMed1987

Thrombotic and bleeding complications of prosthetic heart valves.

A review of articles published since 1979 indicates that thrombotic and bleeding complications account for about 50% of valve-related complications in patients with bioprosthetic aortic and mitral valves and for approximately 75% of the complications in patients with mechanical valves. Although compromised by lack of standard definitions and by variability in reporting and follow-up, the data suggest that the linearized rate of both thrombotic and bleeding complications in patients with aortic bioprostheses is approximately half that for aortic mechanical prostheses (2% versus 4%), but is approximately equal for both bioprostheses and mechanical valves in the mitral position (approximately 4%), and for mechanical and bioprosthetic aortic and mitral valves in combination. However, linearized rates for fatal thrombotic and bleeding events are two to four times higher in patients with mechanical prostheses. The adequacy of warfarin anticoagulation is the most important factor affecting thrombotic and bleeding complications in patients with mechanical valves and over shadows the dubious importance of other phenomena such as atrial fibrillation and left atrial thrombus. Short-term warfarin anticoagulation or the use of long-term platelet inhibitors, or both, do not appear to reduce the incidence of thrombotic complications in patients with aortic bioprostheses but increase bleeding. For mitral bioprostheses, the postoperative use of warfarin for three months or aspirin indefinitely is as effective in preventing thromboembolism as long-term warfarin. Acute prosthetic valve endocarditis is associated with a 13 to 40% incidence of thrombotic complications. Likewise, the recurrence rate of cerebral emboli is high (20-30%) in patients with prosthetic valves who are not anticoagulated. Bioprostheses are strongly preferred for women who wish to bear children; fetal wastage occurs in 25 to 30% of pregnant women with mechanical heart valves who receive either warfarin or heparin, or a combination of the two. Heparin, however, greatly increases the risk of maternal bleeding. In children, the efficacy of platelet inhibitors without warfarin anticoagulation is unproven; nearly all serious strokes occur when warfarin is omitted; and permanent disability from warfarin-related bleeding is rare. All prosthetic cardiac valves initiate coagulation and affect the dynamic equilibrium between activated procoagulants and endogenous anticoagulants. Warfarin is the only available oral exogenous anticoagulant.(ABSTRACT TRUNCATED AT 400 WORDS)

Anticoagulants↗
PubMed2000

Bleeding and spontaneous abortion after therapy for infertility.

OBJECTIVE: To determine the incidence of early-pregnancy bleeding and spontaneous abortion (SAB) after various treatments for infertility and to assess whether bleeding is predictive of SAB. DESIGN: An historic cohort study of women who conceived after various treatments. SETTING: Hospital-based private practice. PATIENT(S): We studied 418 patients in whom 500 consecutive clinical pregnancies occurred. INTERVENTION(S): Patients were grouped according to the method of conception: ovulation induction, IVF, and other. The latter category included interventions not requiring ovulation induction, such as surgery and insemination. A fourth group of subjects who conceived independently of treatment was used as the control. MAIN OUTCOME MEASURE(S): Bleeding and pregnancy outcome (SAB, ectopic pregnancy, or ongoing pregnancy). RESULT(S): Rates of SAB did not differ among the treatment groups. SAB occurred significantly more often after bleeding than when bleeding did not occur (30.8% versus 19.8%, respectively). Bleeding was predictive of SAB only in patients <35 years old (odds ratio 2.4). CONCLUSION(S): Infertile women who conceive after reproductive therapy are not at increased risk for SAB compared with women who conceive naturally. There appears to be no association between previous diagnosis or treatment and the occurrence of SAB in previously infertile women. Bleeding is associated with a twofold relative risk of SAB.

Abortion, Spontaneous↗
PubMed2003

Bleeding patterns after immediate vs. conventional oral contraceptive initiation: a randomized, controlled trial.

OBJECTIVE: To compare bleeding patterns after immediate vs. conventional oral contraceptive (OC) initiation. DESIGN: Randomized controlled trial. SETTING: University-based clinic. PATIENT(S): One hundred thirteen women initiating combination OCs. INTERVENTION(S): Participants received a 4-month supply of a monophasic 35-microg ethinyl E(2) (EE) OC and a bleeding diary, were randomized to immediate or conventional OC start, underwent monthly telephone follow-up, and after 90 days returned the diary and completed an exit interview. MAIN OUTCOME MEASURE(S): Total number of bleeding-spotting days, using the World Health Organization 90-day reference period method. Comparisons were made by trial assignment (immediate vs. conventional) and cycle day of OC initiation (day 8+ vs. days 1-7). RESULT(S): There was no significant difference in the number of bleeding-spotting days (mean difference: -0.5 days; 95% CI: -3.4 to 2.3) or any other bleeding parameter between the immediate and conventional starters, or days 1-7 and day 8+ starters. CONCLUSION(S): Immediate start of OCs does not induce bleeding patterns different from conventional starting regimens. Concern about adverse bleeding patterns should not be considered a justification for instructing women to wait until menses before starting OCs.

Adult↗
PubMed1998

"Salvage" transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding.

BACKGROUND & AIMS: The optimal emergency treatment for gastric fundal variceal bleeding is still unclear. In this study, the efficacy of transjugular intrahepatic portosystemic stent/shunt (TIPS) in patients with uncontrolled gastric fundal vs. esophageal variceal bleeding was compared. METHODS: One hundred twelve consecutive patients with uncontrolled variceal bleeding required emergency TIPS, 84 with esophageal varices (EV group) unresponsive to endoscopic and vasoconstrictor therapy and 28 with gastric fundal varices (GV group) unresponsive to vasoconstrictor therapy. Clinical and biochemical data were retrieved, and the two groups were compared. RESULTS: Variceal bleeding was controlled in all patients after TIPS except for 1 in each group. There were no significant differences between the two groups in terms of markers of disease severity, severity of bleeding, or portal hemodynamics. During a median follow-up period of 7 months, 20 in the EV group (24%) and 8 in the GV group (29%) developed clinical rebleeding. Most early rebleeding (within 7 days after TIPS) was related to esophageal ulceration secondary to previous sclerotherapy. Rates of mortality were similar in both groups. CONCLUSIONS: These results suggest that emergency TIPS is equally effective in the immediate short-term control of gastric fundal variceal bleeding compared with esophageal variceal bleeding.

Adult↗
PubMed1999

Helicobacter pylori and risk of ulcer bleeding among users of nonsteroidal anti-inflammatory drugs: a case-control study.

BACKGROUND & AIMS: Peptic ulcer complications related to use of nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common serious adverse drug reactions. Whether Helicobacter pylori infection potentiates this gastrointestinal toxicity of NSAIDs is still unresolved. In this study, we investigated the role of H. pylori as a cause of bleeding peptic ulcer among NSAID users. METHODS: A case-control study of current users (n = 132) of NSAIDs (including acetylsalicylic acid), admitted because of bleeding peptic ulcer, was performed. Controls were 136 NSAID users without gastrointestinal complications. H. pylori was diagnosed by either increased levels of serum immunoglobulin G or by 13C-urea breath test. RESULTS: Fifty-eight (44%) case subjects had a bleeding gastric ulcer, 54 (41%) had a bleeding duodenal ulcer, 12 (9%) had both gastric and duodenal ulcers, and 8 (6%) had hemorrhagic gastritis. H. pylori was present in 75 (57%) cases compared with 59 (43%) controls. The adjusted odds ratio of bleeding peptic ulcer among NSAID users associated with H. pylori infection was 1.81 (95% confidence interval, 1.02-3.21). H. pylori accounted for approximately 24% of bleeding peptic ulcers among elderly NSAID users. CONCLUSIONS: NSAID users infected with H. pylori have an almost twofold increased risk of bleeding peptic ulcer compared with NSAID users without H. pylori.

Adult↗
PubMed2003

The role of endoscopic Doppler US in patients with peptic ulcer bleeding.

BACKGROUND: Stigmata of recent hemorrhage are important prognostic signs for patients with ulcer bleeding, but these are subjective findings. This study evaluated the additional diagnostic value of Doppler US assessment in patients with a bleeding peptic ulcer. METHODS: A prospective, multicenter study was performed of patients with ulcer bleeding. Stigmata of recent hemorrhage were classified according to the Forrest classification, after which the ulcer was assessed by using an endoscopic Doppler US system. Patients with a Forrest Ib-IIb ulcer with a positive Doppler signal received endoscopic therapy. Patients with a Forrest IIc-III ulcer with a positive Doppler signal were allocated randomly to endoscopic therapy or no therapy. No ulcer without a Doppler signal was treated. RESULTS: A total of 80 patients were enrolled. Of the Forrest Ib-IIb ulcers, 82% had a positive Doppler signal. Of the Forrest IIc-III ulcers, 53% had a positive Doppler signal. There was no difference in the rates of recurrent bleeding, surgery, or mortality between the group with Forrest Ib-IIb ulcers and between the Forrest IIc-III group with and without Doppler signal, but there was little power in the sample size to detect differences. Bleeding recurred in 3 patients without a Doppler signal. Recurrent bleeding was more frequent in the group in which a Doppler signal was still present immediately after endoscopic therapy (3/11 vs. 1/27; p=0.06). CONCLUSIONS: This study did not substantiate a role for endoscopic Doppler US when this was added to the Forrest classification for making clinical decisions in patients with ulcer bleeding.

Aged↗
PubMed2004

Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis.

BACKGROUND: The value of band ligation for prevention of the first episode of variceal bleeding has not been fully evaluated. This study compared the efficacy and safety of band ligation vs. treatment with a beta-blocker for the prophylactic prevention of first bleeding in patients with cirrhosis and high-risk esophageal varices. METHODS: A total of 100 patients with cirrhosis and endoscopically determined high-risk esophageal varices but no history of bleeding were randomized to band ligation (50 patients) or treatment with nadolol (50 patients). In the ligation group, two to 4 elastic bands were deployed during each session. Ligation was repeated at intervals of 3 to 4 weeks until variceal obliteration was achieved. In the nadolol group, the dose of the drug, administered once daily, was sufficient to reduce the pulse rate by 25%. RESULTS: In the ligation group, variceal obliteration was achieved in 41 patients (82%), at a mean of 2.7 (1.1) ligation sessions. In the nadolol group, the mean daily dose of nadolol administered was 60 (20) mg. During follow-up (median approximately 22 months), 10 patients (20%) in the ligation group and 16 (32%) in the nadolol group had upper-GI bleeding (p=0.23). Esophageal variceal bleeding occurred in 5 patients (10%) in the ligation group and 9 (18%) in the nadolol group (p=0.31). By multivariate Cox analysis, Child-Pugh class was the only factor predictive of variceal bleeding. Minor complications were noted in 9 patients (18%) in the ligation group and 4 (8%) in the nadolol group (p=0.35). No serious complication was encountered. Twelve patients in the ligation group and 11 in the nadolol group died (p=0.62). One patient in the ligation group and 3 in the nadolol group died from uncontrollable variceal hemorrhage. CONCLUSIONS: Variceal ligation is as effective and as safe as treatment with nadolol for prevention of first variceal bleeding in patients with cirrhosis.

Adult↗
PubMed2004

Combined epinephrine and bipolar probe coagulation vs. bipolar probe coagulation alone for bleeding peptic ulcer: a randomized, controlled trial.

BACKGROUND: Endoscopic treatment with combined modalities is considered standard of care for patients with high-risk peptic ulcer bleeding. This study compared epinephrine injection plus bipolar probe coagulation with bipolar probe coagulation alone in patients with high-risk peptic ulcer bleeding. METHODS: Patients with endoscopically confirmed peptic ulcer bleeding (active or visible vessel) seen from January 2000 through December 2002 were prospectively randomized to two groups. The study group (n = 58) had epinephrine injection followed by bipolar coagulation; the control group (n = 56) was treated by bipolar coagulation alone. The primary outcomes assessed were the rate of initial hemostasis and the rate of recurrent bleeding. Secondary outcomes were the following: need for surgical intervention to control bleeding, transfusion requirements, length of hospital stay (in days), and 30-day mortality. RESULTS: The rate of initial hemostasis was significantly higher in the combination therapy group ( p = 0.02; absolute risk reduction 31.6%: 95% CI [5.4, 57.7]). There was no significant difference between the two treatment groups with respect to all other outcomes measures, except that significantly fewer units of blood were transfused in the combination therapy group ( p = 0.006). CONCLUSIONS: In patients with active peptic ulcer bleeding, epinephrine injection plus bipolar coagulation achieved significantly higher rate of initial hemostasis. All other outcome measures were similar with either treatment in patients with non-bleeding stigmata.

Acute Disease↗
PubMed1986

Endoscopic injection sclerosis in bleeding gastric varices.

Ninety-two consecutive, nonrandomized patients with bleeding varices were prospectively studied using sclerotherapy to control and prevent rebleeding. During this study, nine patients with gastric variceal bleeding were identified. A gastric variceal subset is defined and represents a 10% incidence in this series. All patients presented with indexed gastric bleeding varices that subsequently accounted for 34 bleeding sessions. The units of blood per rebleeding episode, hospital days, cost, and outcome were markedly different from the esophageal variceal groups. Initial management of indexed bleeding episodes by sclerotherapy and Sengstaken-Blakemore tubes were comparable; however, the number of rebleeding episodes was much higher. There was poor control of rebleeding with an associated higher rebleeding mortality and complications secondary to repeated sclerotherapy and Sengstaken-Blakemore tube use. In 37% of the patients, rebleeding was the direct result of gastric ulcerations at the endoscopic injection sclerotherapy site. The survival curve of this group was much lower than esophageal variceal bleeders. Endoscopic injection sclerotherapy in patients with bleeding gastric varices offers only temporary control of bleeding, and the high incidence of severe early rebleeding requires consideration of alternative methods for management or modified sclerotherapy techniques.

Esophageal and Gastric Varices↗
PubMed1987

Endoscopic sclerotherapy for bleeding esophageal varices secondary to extrahepatic portal vein obstruction.

Portal hypertension and variceal bleeding secondary to extrahepatic portal vein obstruction continue to present a therapeutic challenge. We performed endoscopic injection sclerotherapy in eight patients with extrahepatic portal vein obstruction and bleeding esophageal varices. In contrast to other reported series, all but one of our patients were adults at the time sclerotherapy was initiated. Six had episodes of continued bleeding after a variety of surgical procedures. After sclerotherapy, five had no further bleeding with a mean follow-up of 26 months. Three patients had episodes of bleeding prior to variceal obliteration; two of these patients underwent surgical intervention after emergency sclerosis to stabilize their condition. Transfusion requirements were less after sclerosis (p = 0.035), although the follow-up has been relatively short (mean, 24 months) compared to the duration of bleeding. Our results suggest that endoscopic sclerotherapy is an effective therapeutic alternative, and perhaps the initial treatment of choice, in patients with extrahepatic portal vein obstruction and bleeding esophageal varices.

Adolescent↗
PubMedDate not supplied

Bleeding following endoscopic sphincterotomy: angiographic management by transcatheter embolization.

Transcatheter embolization is a well-established and effective method for the control of bleeding from the upper gastrointestinal tract and often represents the preferred alternative to more invasive surgical management. The applications of this technique for the management of bleeding following endoscopic sphincterotomy have not been reported previously. Of five patients referred for arteriography with life-threatening postsphincterotomy bleeding, active bleeding from branches of the gastroduodenal artery was demonstrated in four. Embolization of this vessel with Gelfoam controlled the bleeding in all three patients in whom it was attempted. Arterial stenosis and spasm precluded such treatment in one patient. The fifth patient was not bleeding at the time of arteriography. There were no complications from these procedures. Our experience shows that postsphincterotomy bleeding can be safely and effectively controlled by transcatheter embolization, thereby avoiding surgery which is associated with significant morbidity and mortality in this setting.

Adult↗
PubMedDate not supplied

The role of endoscopic injection sclerotherapy in the management of bleeding peristomal varices.

Peristomal varices usually occur in patients with enterostomies who develop portal hypertension, and represent a cause of recurrent or intractable gastrointestinal bleeding. Treatment options for such bleeding include surgical ligation of varices, stoma revision with devascularization, injection sclerotherapy, portacaval shunt, or liver transplantation. We reviewed the records of seven patients with peristomal varices, who were followed for a mean of 17 months after diagnosis. Fourteen episodes of clinically significant peristomal bleeding occurred in six patients. Surgical ligation of varices was ineffective in controlling bleeding in two of three patients, although stoma revision with devascularization was temporarily effective in two other patients. Injection sclerotherapy, used in three patients, effectively controlled acute bleeding without serious complications or need for surgery. Definitive treatment for peristomal bleeding (portacaval shunt or liver transplantation) has prevented any further bleeding in three patients for a mean of 8 months after surgery.

Endoscopy↗
PubMed1996

Bleeding from gastric antral vascular ectasia in marrow transplant patients.

BACKGROUND: Gastric antral vascular ectasia (GAVE) leads to blood loss in the disorders of "watermelon stomach" and portal gastropathy, but is not a commonly recognized complication of marrow transplantation. METHODS: GAVE was diagnosed when capillary ectasia, focal capillary thromboses, and fibromuscular hyperplasia were identified in antral mucosal biopsy specimens. Marrow transplant patients bleeding from GAVE were reviewed to ascertain common variables in their pretransplant, posttransplant, and bleeding course. RESULTS: Six patients developed bleeding due to GAVE. The onset of bleeding was 18 to 94 days after transplant and required an average of 37 U of blood (range, 2 to 130 U). Two patients stopped bleeding after restoration of platelet counts. Two patients had surgical antral resections; both died of multiorgan failure after surgery. Two patients had successful endoscopic laser ablation of vascular lesions and survived. Factors possibly associated with GAVE included male gender, VOD of the liver, oral busulfan as part of the conditioning regimen, and growth factor use after transplant. CONCLUSIONS: GAVE was a cause of gastric bleeding in six patients with marrow transplant patients. Restoration of platelet counts and endoscopic laser photocoagulation are the therapies of choice for ongoing bleeding in these patients.

Adolescent↗
PubMed1999

Total peroral intraoperative enteroscopy for obscure GI bleeding using a dedicated push enteroscope: diagnostic yield and patient outcome.

BACKGROUND: Intraoperative enteroscopy is an effective diagnostic and therapeutic method in selected patients with obscure gastrointestinal (GI) bleeding. The passage of a colonoscope orally and then rectally or the use of multiple enterotomies, has been used to completely inspect the small bowel. However, the development of dedicated enteroscopes allows complete inspection using the peroral route. AIM: The aim of the study was to assess the diagnostic yield, patient outcome, and success in reaching the terminal ileum using a video enteroscope passed orally during intraoperative enteroscopy. METHODS: The hospital charts of 12 patients who underwent intraoperative enteroscopy for GI bleeding of obscure origin and 2 patients with a known source (angioectasias) who underwent evaluation to determine extent were retrospectively analyzed. RESULTS: The terminal ileum was reached in 13 of 14 patients (jejunal stricture in 1 patient). Of the patients with bleeding of obscure origin (n = 12) a source was identified in 7 (angioectasias 4, lymphoma 1, carcinoid 1, nevuslike lesion 1). Surgical therapy was performed in these 7 patients and resulted in no further bleeding in 5. Bleeding recurred in 4 of the 5 patients who had no source identified during intraoperative enteroscopy. Of the 2 patients undergoing intraoperative enteroscopy to evaluate extent of angioectasias, additional angioectasias were found in 1 patient; both patients underwent surgical resection, and 1 patient had recurrent bleeding. Complications included serosal tears, 3 (2 requiring resection); avulsion of superior mesenteric vein, 1; postoperative congestive heart failure, 2; azotemia, 1; and prolonged ileus, 1. There were no deaths. CONCLUSIONS: The terminal ileum was reached 93% of the time with intraoperative enteroscopy. For patients with GI bleeding of obscure origin the diagnostic yield of intraoperative enteroscopy was 58%. Major operative morbidity occurred in 4 patients.

Aged↗