Effects of hemoclips on preventing delayed bleeding for patients with early gastric cancer after endoscopic submucosal dissection / 中华消化内镜杂志

Objective:To evaluate the effects of hemoclips on preventing delayed bleeding for early gastric cancer (EGC) after endoscopic submucosal dissection (ESD).Methods:Clinical data of 459 patients who underwent ESD for EGC in Beijing Friendship Hospital from June 2013 to August 2020 were collected retrospectively. Patients were divided into group A (hemoclip group, n=162) and group B (non-hemoclip group, n=297) according to whether preventive hemostatic clip treatment was performed after resection. Delayed bleeding within 2 weeks after ESD was observed. Univariate analysis and subgroup analysis were conducted for the delayed bleeding incidence and clinicopathological features. Results:Delayed bleeding incidences of group A and group B were 3.1% (5/162) and 8.1% (24/297) with significant difference between the two groups ( χ2=4.418, P=0.036). Subgroup analysis showed that there were significant differences in the delayed bleeding incidence between the two groups when the diameter of the tumor >20 mm [3.5% (2/57) VS 15.3% (13/85), χ2=5.016, P=0.025], the tumor located in the lower part of the stomach [1.0% (1/97) VS 10.4% (20/192), χ2=8.425, P=0.004], and the depth of tumor invasion was M/SM1 [3.2% (5/157) VS 8.1% (23/285), χ2=4.072, P=0.044]. There were no significant differences in the delayed bleeding incidence between group A and group B when the diameter of the tumor ≤20 mm, the tumor located in the upper/medial part of the stomach and the depth of tumor invasion was SM2 ( P>0.05). Conclusion:Hemoclips can prevent delayed bleeding after ESD for EGC, which is mainly observed in a tumor of diameter >20 mm, located in the lower part of the stomach and M/SM1 tumor invasion. It has little effect on the prevention when the tumor diameter ≤20 mm and located in the upper/medial part of the stomach.

Diagnostic and therapeutic value of emergency gastroscopy for upper gastrointestinal bleeding combined with post percutaneous coronary intervention / 中华消化内镜杂志

From June 2015 to June 2020, 52 patients who underwent emergency gastroscopy and treatment for upper gastrointestinal bleeding after percutaneous coronary intervention (PCI) at the Renmin Hospital of Wuhan University were included and retrospectively analyzed. The etiologic diagnosis of bleeding, results of hemostatic treatment and occurrence of complications during the emergency gastroscopy were observed. Among the 52 patients, 47 cases (90.4%) were found to have lesions that could explain upper gastrointestinal bleeding under emergency gastroscopy, and the remaining 5 cases (9.6%) could not clearly diagnose the cause of bleeding. Twenty-six cases (50.0%) were treated with emergency endoscopic hemostasis, of which 25 cases (96.2%) were successful. The median time for emergency endoscopy was 18 min. Seven cases (13.5%) had transient slowing of heart rate and lowering of blood pressure without serious complications. This shows that emergency gastroscopy is safe and effective in the diagnosis and treatment of upper gastrointestinal bleeding combined with post-PCI.

Hepatic venous pressure gradient affects the efficacy of endoscopic treatment of gastroesophageal varices in hepatitis B cirrhosis / 中国医师杂志

Objective:To investigate the effect of hepatic venous pressure gradient (HVPG) on the prevention of rebleeding in cirrhotic patients of hepatitis B with gastroesophageal variceal hemorrhage receiving endoscopic therapy, and its influence on prognosis.Methods:Fifty eight patients with esophageal and gastric varices due to cirrhosis of hepatitis B admitted to Minhang Hospital Affiliated to Fudan University (from January 2019 to September 2021, n=18) and Zhongshan Hospital Affiliated to Fudan University (from January to September 2017, n=40) were retrospectively included. All of them underwent HVPG determination and endoscopic treatment. They were divided into HVPG≤18 mmHg group and HVPG>18 mmHg group. The rebleeding and survival status of these patients with endoscopic treatment was compared after a follow-up period of 2 years, and Cox regression was performed to analyze the related factors for rebleeding and survival. Results:A total of 58 individuals were included, which were divided into two groups: HVPG≤18 mmHg group (35) and HVPG>18 mmHg group (23). During the 2-year follow-up after the first endoscopic treatment, 13 patients (22.41%) developed rebleeding, including 4 patients in the HVPG≤18 mmHg group and 9 patients in the HVPG>18 mmHg group. The non-bleeding rate in HVPG≤18 mmHg group was significantly higher than that in HVPG>18 mmHg group (91.3% vs 68.7%, RR=3.54, 95% CI: 1.08-11.60, P=0.026), and the difference was statistically significant. Four patients died, including 1 patient in the HVPG≤18 mmHg group and 3 patients in the HVPG>18 mmHg group. There was no statistically significant difference in 2-year survival between the two groups (96.7% vs 86.5%, RR=4.44, 95% CI: 0.45-43.58, P=0.162). Cox regression multivariate analysis was used to analyze the above data, and the results suggested portal vein thrombosis ( HR=3.826, 95% CI: 1.263-11.585, P=0.018), HVPG>18 mmHg ( HR=4.243, 95% CI: 1.290-13.955, P=0.017) were independent risk factors for rebleeding in 2 years after endoscopic therapy. Conclusions:For patients with high HVPG, it should be fully evaluated and considered to receive other pressure lowering therapy, and treatment conversion should be carried out as soon as possible after endoscopic treatment failure.

Clinical evaluation of different modalities in emergency endoscopic treatment of esophageal variceal bleeding / 中国医师杂志

Objective:This study aimed to evaluate the rebleeding risk and prognosis of patients being treated after acute esophageal varices bleeding by two different treatment strategies: sclerosing agent combined with tissue glue injection, esophageal varices ligation (EVL), through comparing the therapeutic effects and securities.Methods:A total of 76 patients who underwent endoscopy and received treatment in Zhongshan Hospital Affiliated to Fudan University due to acute esophageal variceal bleeding were included retrospectively. 6 patients with active bleeding and 70 patients with thrombus in esophagus varices under gastroscopy. Among them, 21 cases were treated with sclerosing agent combined with tissue glue injection (sclerosing tissue glue group), and 55 cases were treated with EVL (EVL group). The emergency endoscopic diagnosis and treatment of the two groups were compared, and the risk factors of rebleeding 6 months after endoscopic treatment were analyzed by univariate and multivariate analysis.Results:All patients received endoscopic treatment successfully. During the follow-up period of 6 months after endoscopic treatment, rebleeding occurred in 13 cases. Kaplan Meier analysis showed that the 6-month rebleeding rate in the sclerosing tissue glue group was significantly higher than that in the EVL group (41.6% vs 12.3%, P=0.011). There were 8 deaths in total. Kaplan Meier analysis showed that there was no significant difference in 6-month mortality between the two groups (17.5% vs 10.1%, P=0.616). Multivariate analysis further showed that malignant tumor ( HR=3.700, 95% CI: 1.187-11.536, P=0.024) and treatment mode of esophageal variceal bleeding ( HR=4.834, 95% CI: 1.443-16.193, P=0.011) were independent risk factors for rebleeding 6 months after endoscopic treatment of acute esophageal variceal bleeding. Conclusions:This study found that EVL and the combining injection of lauromacrogol and cyanoacrylate could be used in emergent hemostatic treatment for acute esophageal varices bleeding. Moreover, EVL is the prioritized approach in endoscopic emergency treatment with a lower rebleeding rate and fewer complications. Sclerotherapy combined with tissue glue can be used as one of the measures of emergency treatment, which is not better than ligation.

Vascular embolization for acute non-variceal upper gastrointestinal rebleeding after conventional endoscopic hemostasis / 中华消化内镜杂志

From April 2017 to June 2020, 46 patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB) underwent endoscopic vascular embolization (EVE) in the Department of Gastroenterology of the First Affiliated Hospital of University of Science and Technology of China for rebleeding after endoscopic hemostasis therapy (including local drug injection, electrocoagulation, hemostatic clamp and ligation, etc.). All 46 patients immediately stopped bleeding after EVE, and the effective rate of immediate hemostasis was 100.0%. Postoperative abdominal pain occurred in 13 cases (28.3%), abdominal distension in 3 cases (6.5%) and fever in 2 cases (4.3%). The mucosa healed gradually under gastroscopy 3 and 12 months after the operation. No gastrointestinal rebleeding occurred during the follow-up. Therefore, EVE is a safe and effective method for ANVUGIB patients with failure of initial endoscopic hemostasis, which is worthy of further clinical study and application.

Evaluation of polysaccharide hemostatic system for arterial hemorrhage of upper digestive tract / 中华消化内镜杂志

Objective:To study the efficacy and safety of EndoClot polysaccharide hemostatic system (EndoClot PHS) for heparinized arterial hemorrhage of upper digestive tract (Forrest Ⅰa) in animal model.Methods:Twelve experimental pigs were randomly divided into the test group ( n=6) and the control group ( n=6) by simple random grouping method. Gastric arterial hemorrhage models were established. Endoclot PHS and Hemospray were used to spray on the wound to stop bleeding in the test group and the control group respectively. The time of effective hemostasis, the amount of hemostatic particles used, and the blockage of the powder feeding tube and its replacement were compared between the two groups. The survival and complications of experimental pigs were observed after the operation. In 10 days after the operation, the experimental pigs were euthanized for pathological dissection. Results:Spurting or pulsatile bleeding was achieved in all experimental pigs. There were significant differences in the time of effective hemostasis (8.75±0.84 min VS 9.83±0.62 min, t=-2.53, P=0.030) and the amount of hemostatic particles used to achieve effective hemostasis (6.71±0.39 g VS 14.10±1.62 g, t=-10.86, P<0.001) between the test group and the control group. There was no significant difference in the occurence of clogging or the replacement of powder feeding pipes between the two groups (0.64±0.02 times VS 0.67±0.04 times, t=-1.64, P=0.131). In addition, the gas source of the test group was stable, and the visual field under the endoscope was clear. Neither the test group nor the control group had gastric lesions, perforation, or embolism. The blood glucose, blood routine, and liver and kidney functions were normal, and no thrombosis or embolism of the main organs occurred in either group. Conclusion:EndoClot PHS is safe and effective for heparinized upper gastrointestinal arterial hemorrhage (Forrest Ⅰa) in animal models.

The controlled study of efficacy and safety of infusion of ilaprazole sodium versus esomeprazole sodium in prevention of peptic ulcer rebleeding / 中华消化杂志

Objective:To explore the efficacy and safety of intermittent infusion of ilaprazole sodium and high-dose continuous infusion of esomeprazole sodium in preventing rebleeding in patients with peptic ulcer bleeding after successful endoscopic hemostasis.Methods:This is a multi-center, interval randomized, double-blind, double-dummy, parallel controlled study. From March 3rd to June 15th, 2021, 151 patients with high risk of peptic ulcer bleeding and successfully underwent endoscopic hemostasis from 33 hospitals including the First Affiliated Hospital of Zhejiang University School of Medicine were enrolled. Patients were interval randomly divided into the trial group (74 cases) and the control group (77 cases). Patients in the trial group received intermittent intravenous infusion of ilaprazole sodium once daily (20 mg administered as a 60 min intravenous infusion on day 1, and 10 mg administered as a 30 min intravenous infusion on day 2 and 3); patients in the control group received continuous intravenous infusion of esomeprazole sodium for 72 h (esomeprazole sodium 80 mg at first dose in half an hour, and 8 mg per hour continuous intravenous infusion for 71.5 h). After intravenous infusion treatment, patients of both groups were given oral ilaprazole enteric-coated tablets, 10 mg each time, once a day for 4 d. The rebleeding rate after 72 h and within 7 d after treatment and the proportion of patients who received endoscopic retreatment or surgery due to rebleeding within 72 h after treatment were analysised based on the full analysis set (72 cases in the trial group and 75 cases in the control group); and the incidence rate of adverse reactions was observed in the two groups based on the safety analysis set (74 cases in the trial group and 76 cases in the control group). Chi-square test or Fisher exact probability test was used for statistical analysis.Results:There was no rebleeding case in the trial group within 72 h and 1 case of rebleeding within 7 d (1.39%, 1/72). In the control group, there was 1 case of rebleeding (1.33%, 1/75) within 72 h and 4 cases of rebleeding (5.33%, 4/75) within 7 d. There was no significant difference in rebleeding rate either after 72 h or within 7 d after treatment between the two groups (both P>0.05). Within 72 h of treatment, no patients in both groups needed endoscopic or surgical retreatment due to rebleeding. Adverse reactions occurred in 5 cases (6.8%, 5/74) and 6 cases (7.9%, 6/76) in the trial group and control group, respectively, which recovered spontaneously without treatment. No serious adverse reactions occurred in both groups. Conclusion:In patients with high-risk peptic ulcer bleeding with successful endoscopic hemostasis, intermittent intravenous infusion of ilaprazole sodium has similar efficacy and safety as continuous high-dose intravenous infusion of esomeprazole sodium, but the dosage of intermitten regimen is less, the administration is more convenient, and it is worthy of clinical promotion.

Risk factors for hemostatic failure in emergency gastroscopic sclerotherapy combined with tissue adhesive injection for esophagogastric variceal bleeding with portal vein embolus / 临床肝胆病杂志

ObjectiveTo investigate the risk factors for failure in emergency endoscopic injection sclerotherapy (EIS) combined with sequential histoacryl injection (HI) for esophagogastric variceal bleeding (EGVB) with portal vein embolus (PVE). MethodsA total of 109 EGVB patients with PVE who underwent emergency gastroscopy in Beijing Shijitan Hospital, Capital Medical University, and The Fifth Medical Center of Chinese PLA General Hospital from January 2018 to December 2019 were enrolled, and according to the outcome of hemostatic treatment under emergency gastroscopy, the patients were divided into hemostatic failure group with 28 patients and hemostatic success group with 81 patients. The two groups were compared in terms of general information, varices and bleeding manifestations under gastroscopy, blood biochemical parameters, Child-Pugh class, and Model for End-Stage Liver Disease (MELD) score, and the risk factors for hemostatic failure were analyzed. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a logistic regression analysis was used for multivariate analysis. ResultsCompared with the hemostatic success group, the hemostatic failure group had significantly higher peripheral white blood cell count (WBC), total bilirubin (TBil), Child-Pugh class, and MELD score (Z=3.794, Z=4.751, χ2=40.104, Z=6.412, all P＜0001) and significantly lower prothrombin time activity (PTA), albumin (Alb), and cholinesterase (CHE) (t=9.653, Z=3.093, Z=4.092, P＜0.001, P=0.002, and P＜0.001). WBC (odds ratio ［OR］=28.543, 95% confidence interval ［CI］: 1.285-634.113, P＜0.05), PTA(OR=0.194, 95%CI: 0.045-0.835, P＜0.05), TBil (OR=2.197, 95%CI: 1.004-4.810, P＜0.05), Alb (OR=0448, 95%CI: 0.209-0.961, P＜0.05), and Child-Pugh class (OR=5.164, 95%CI: 1.307-20.406, P＜0.05) were independent risk factors for hemostatic failure. ConclusionWBC, PTA, TBil, Alb, and Child-Pugh class are independent risk factors for failure in emergency EIS combined with sequential HI in the treatment of EGVB with PVE, and adequate preoperative evaluation and correction may help to improve the success rate of hemostasis.

Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding

BACKGROUND/AIMS: The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12–24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. METHODS: This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding. RESULTS: A total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome. CONCLUSIONS: Very early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.

Application effect of gastroscopic hemostasis combined with limited fluid resuscitation in the treatment of upper gastrointestinal bleeding in patients with liver cirrhosis / 中国基层医药

Objective@#To evaluate the effect of gastroscopic hemostasis combined with limited fluid resuscitation in the treatment of upper gastrointestinal bleeding in patients with liver cirrhosis.@*Methods@#From December 2016 to June 2018, 100 liver cirrhosis patients with upper gastrointestinal bleeding in Yuncheng Central Hospital were divided into control group(n=50) and observation group(n=50) according to non-randomized non-inferiority.The control group was treated with limited fluid resuscitation, and the observation group was treated with gastroscopic hemostasis combined with limited fluid resuscitation.The therapeutic effects of the two groups were compared.@*Results@#The recovery rate, 24-hour hemostasis rate of the observation group were 98.00%(49/50), 68.00%(34/50), respectively, which were higher than those of the control group [82.00%(41/50), 16.00%(8/50)], and the clinical mortality rate of the observation group was 2.00%(1/50), which was lower than 16.00%(8/50) of the control group, the differences were statistically significant(χ2=5.444, 25.657, 4.396, all P<0.05). The time of hemostasis, ventilator detachment and ICU detachment in the observation group were shorter than those in the control group[(1.34±0.28)d vs.(2.05±0.43)d, (1.68±0.42)d vs.(2.59±0.51)d, (2.85±0.72)d vs.(5.19±1.03)d], the differences were statistically significant(t=9.784, 9.739, 13.166, all P<0.001). The incidence of complications, rehaemorrhage rate within 6 months in the observation group were 4.00%(2/50), 2.00%(1/50), respectively, which were lower than those in the control group [22.00%(11/50), 16.00%(8/50)], the differences were statistically significant(χ2=5.659, 4.396, all P<0.05).@*Conclusion@#Gastroscopic hemostasis combined with limited fluid resuscitation in the treatment of upper gastrointestinal bleeding in patients with liver cirrhosis has significant therapeutic effect, high hemostasis rate and few complications.

Therapeutic effects of endoscopic foam sclerotherapy for bleeding internal hemorrhoids / 中华消化内镜杂志

Objective@#To evaluate the safety and efficacy of foam sclerotherapy for bleeding internal hemorrhoids.@*Methods@#Consecutive adult patients (aged 18-60 years) with bleeding hemorrhoids were prospectively enrolled between March 2017 and March 2018. All patients were randomly assigned to the foam sclerotherapy (FS) group and the liquid sclerotherapy (LS) group. The foam and liquid sclerotherapy of hemorrhoids nucleus was performed by cap-assisted colonic endoscopy.@*Results@#A total of 108 patients were enrolled, including 62 males (57.4%) with mean age of 44.0±7.6 years. There was no significant difference in gender, age, or body mass index between the FS (n = 55) group and the LS (n =53) group. The total amount of lauromacrogol injection in the FS group was 3.7±0.9 mL, which was significantly lower than that in the LS group (8.0±2.2 mL, P<0.001). In the LS group, 8 patients (15.1%) developed bleeding after needle removal, which was significantly higher than that in the FS group [5.5%(3/53), P=0.022]. Significant pain was found in 2 patients (3.8%) in the LS group and 0 in the FS group (P= 0.025). The short-term cure rate and effective rate of the FS group were 87.3% (48/55) and 9.1% (5/55), while those were 69.8% (37/53) and 22.6% (12/53) in the LS group, respectively (P=0.046).@*Conclusion@#Foam sclerotherapy is safe and effective in the treatment of bleeding internal hemorrhoids.

Therapeutic effects of endoscopic foam sclerotherapy for bleeding internal hemorrhoids / 中华消化内镜杂志

Objective To evaluate the safety and efficacy of foam sclerotherapy for bleeding internal hemorrhoids. Methods Consecutive adult patients (aged 18-60 years) with bleeding hemorrhoids were prospectively enrolled between March 2017 and March 2018. All patients were randomly assigned to the foam sclerotherapy (FS) group and the liquid sclerotherapy (LS) group. The foam and liquid sclerotherapy of hemorrhoids nucleus was performed by cap-assisted colonic endoscopy. Results A total of 108 patients were enrolled, including 62 males ( 57. 4％) with mean age of 44. 0 ± 7. 6 years. There was no significant difference in gender, age, or body mass index between the FS ( n = 55) group and the LS ( n =53) group. The total amount of lauromacrogol injection in the FS group was 3. 7±0. 9 mL, which was significantly lower than that in the LS group (8. 0±2. 2 mL, P<0. 001). In the LS group, 8 patients (15. 1％) developed bleeding after needle removal, which was significantly higher than that in the FS group [5. 5％(3/53), P=0. 022]. Significant pain was found in 2 patients (3. 8％) in the LS group and 0 in the FS group (P= 0. 025). The short-term cure rate and effective rate of the FS group were 87. 3％( 48/55) and 9. 1％( 5/55) , while those were 69.8％ (37/53) and 22.6％ (12/53) in the LS group, respectively (P=0.046). Conclusion Foam sclerotherapy is safe and effective in the treatment of bleeding internal hemorrhoids.

Role of endoscopic treatment or balloon-occluded retrograde transvenous obliteration in patients with Child-Pugh class C end-stage liver cirrhosis and esophageal/gastric varices

No abstract available.

Analysis of effect of endoscopic electrocoagulation combined with nasal micro packing in the treatment of intractable epistaxis / 中国基层医药

Objective To explore the clinical effect of the endoscopic electrocoagulation combined with nasal micro packing in the treatment of refractory epistaxis .Methods 120 patients with refractory epistaxis were selected as the research subjects ,and they were divided into two groups by the single blind randomly methods ,60 cases in each group.The control group was given vaseline gauze for hemostasis of nasal cavity ,and the observation group received endoscopic electrocoagulation combined with nasal packing hemostasis micro treatment .The cure rate ,the incidence of complications ,recovery of nasal mucosa of nasal ventilation time , recovery time , the total amount of bleeding , pain score and recurrence rate of the two groups were compared .Results The cure rate in the observation group was 96.67％,which was significantly higher than 81.67％ in the control group(χ2 =6.988,P<0.05).The incidence rate of complications and pain score in the observation group were 8.33％,(3.65 ±1.09)points,respectively,which were significantly lower than 21.67％,(5.23 ±1.72) points in the control group (χ2 =4.183,t =6.010,all P<0.05).The total amount of bleeding significantly reduced (t=6.344,P<0.05),the recovery of nasal ventilation time and recovery time of nasal mucosa significantly decreased (t=7.119,6.183,all P<0.05).The patients were followed up for 6 months,the recurrence rate in the observation group was 1.67％,which was significantly lower than 11.67％in the control group(χ2 =4.821,P<0.05).Conclusion The endoscopic electric coagulation combined with nasal micro packing in the treatment of refractory epistaxis has significant effect ,it can effectively promote the recovery of patients,reduce complications and recurrence ,the prognosis is good .

Comprehensive review of outcomes of endoscopic treatment of gastrointestinal bleeding

Gastrointestinal bleeding (GIB) is a major cause of hospital admission and death. Endoscopic treatment is an important therapeutic modality for the treatment of GIB, and can involve injection therapy, thermal therapy, hemoclipping, and ligation therapy. In addition to hemostatic devices, new endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have been developed. The causes, therapeutic modalities, and outcomes of GIB differ according to bleeding source. This review comprehensively describes the outcomes of endoscopic treatment of GIB.

New endoscopic techniques in treating gastrointestinal bleeding

Gastrointestinal (GI) bleeding is a common disorder encountered in an emergency department or primary clinical setting. The therapeutic basis for GI bleeding is endoscopic hemostasis. To date, epinephrine injection, through-the-scope clips, monopolar or biopolar coagulation, and band ligation have been established for GI bleeding. Despite the advances in endoscopic techniques, we often experience re-bleeding associated with significant inhospital mortality in GI bleeding. New devices that complement the disadvantages of these conventional endoscopic techniques have recently been introduced. For example, over-the-scope clip, which has wider and stronger pressure than conventional mechanical devices, can ligate a wide range of surrounding mucous membranes and has been reported to be effective in severe lesions of fibrosis. In addition, hemostatic powders achieved successful hemostasis as primary or rescue therapy in several cases of GI bleeding. Successful application of these new techniques requires appropriate patient selection and understanding of the device and further research is expected in the future.

Recent Developments in the Endoscopic Treatment of Patients with Peptic Ulcer Bleeding

Peptic ulcer bleeding is an internal medical emergency. Endoscopic hemostasis has been shown to improve the survival rate of patients with peptic ulcer bleeding. Although the established hemostatic modalities, including injection, thermal therapy, and mechanical therapy, are effective in controlling peptic ulcer bleeding, hemostasis can be difficult to achieve in some cases. As a result, recent, new endoscopic hemostatic modalities, including over-the-scope clips, topical hemostatic sprays, and endoscopic ultrasonography-guided angiotherapy, have been developed.

Application of a novel endoscopic suture device to endoscopic submucosal dissection / 中华消化内镜杂志

Objective To evaluate a new suture coil in endoscopic submucosal dissection (ESD). Methods Data of 15 patients with early gastrointestinal cancer undergoing ESD were retrospectively ana?lyzed. The edge of the lesion was pulled up by the new coil?assisted suture for the submucosal layer to be full?y revealed, then the submucosa were dissected,and the wound was stitched by suture coil. The success rate and complications were evaluated. Results The lesions were successfully resected in 15 patients. By pull?up, the submucosal blood vessels were completely revealed. No intraoperative uncontrollable bleeding oc?curred. Small perforation occurred in one patient, and was well stitched by the suture coil. The pull?ups were successfully completed in all patients, and the operation time was 5?10 min. The intraoperative slippage of fixed titanium clips occurred in two cases. All the wounds were stitched. Minor bleeding happened in 1 pa?tient, and was controlled by hemostatic clip. Conclusion The new suture coil is easy to use,and can effec?tively prevent and deal with the occurrence of intraoperative and postoperative ESD?related complications.

Management of Patients with Peptic Ulcer Bleeding / 胃肠病学

Peptic ulcer bleeding is a common emergency. Management of peptic ulcer bleeding needs prompt pre-endoscopy risk stratification,initiation of pharmacotherapy,endoscopic assessment and hemostasis if necessary. This article reviewed the proper management of patients with peptic ulcer bleeding based on the most recent relevant international guidelines and consensus.

Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection

BACKGROUND/AIMS: Delayed post-endoscopic submucosal dissection (ESD) bleeding (DPEB) is difficult to predict and there is controversy regarding the usefulness of prophylactic hemostasis during second-look endoscopy. This study evaluated the risk factors related to DPEB, the relationship between clinical outcomes and the Forrest classification, and the results of prophylactic hemostasis during second-look endoscopy. METHODS: Second-look endoscopy was performed on the day after ESD to check for recent hemorrhage or potential bleeding and the presence of artificial ulcers in all patients. RESULTS: DPEB occurred in 42 of 581 patients (7.2%). Multivariate analysis determined that a specimen size ≥40 mm (odds ratio [OR], 3.03; p=0.003), and a high-risk Forrest classification (Forrest Ib+IIa+IIb; OR, 6.88; p<0.001) were risk factors for DPEB. DPEB was significantly more likely in patients classified with Forrest Ib (OR, 24.35; p<0.001), IIa (OR, 12.91; p<0.001), or IIb (OR, 8.31; p<0.001) ulcers compared with Forrest III ulcers. There was no statistically significant difference between the prophylactic hemostasis and non-hemostasis groups (Forrest Ib, p=0.938; IIa, p=0.438; IIb, p=0.397; IIc, p=0.773) during second-look endoscopy. CONCLUSIONS: The Forrest classification of artificial gastric ulcers during second-look endoscopy seems to be a useful tool for predicting delayed bleeding. However, routine prophylactic hemostasis during second-look endoscopy seemed to not be useful for preventing DPEB.