Experimental control of gastrointestinal hemorrhage via the endoscope: a new era dawns

Research output: Contribution to journalArticle

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Abstract

Panendoscopy has now been clearly shown to be a safe and highly accurate method of diagnosis in the patient with acute upper gastrointestinal hemorrhage. An exact etiological diagnosis has enabled the clinician to employ more selectively the techniques available, including antacids, nasogastric tubes, vasopressin infusion (by peripheral vein or selectively catheterized artery), balloon tamponade, or emergency operation. Unfortunately, none of the methods is entirely satisfactory. Antacids, although useful in prevention of stress ulcers, cannot control active hemorrhage. Intravenous vasopressin, although of temporary benefit in perhaps 50% of patients with bleeding esophageal varices, has significant hemodynamic side effects. Selective intraarterial vasopressin in a well controlled study provided temporary control of both variceal and non variceal bleeders, but had no effect on mortality. In addition, this technique requires considerable technical skill and expense and carries several risks including arrhythmia, acute myocardial infarction, bacteremia, embolization, thrombosis, and water retention with hyponatremia. Balloon tamponade, although effective in up to 75% of variceal bleeders, carries significant risk including esophageal necrosis and asphyxiation. Emergency surgery in an acute gastrointestinal bleeder is associated with a very high mortality. Thus, despite early diagnosis now available in 90% of acute bleeders, continued bleeding or early recurrence remains a major threat. Mortality has not been dramatically reduced, and runs between 4 and 8%. The endoscopist has become increasingly frustrated with his inability to control directly the observed bleeding lesion(s). Intensive research in many United States centers is presently evaluating several techniques for safe and effective direct transendoscopic control of active gastrointestinal hemorrhage. A review is presented of the various physical, electrical, and chemical modalities being tested with emphasis on the areas believed to be the most promising. Pertinent research data already available will be described. Some guidelines for investigation in this important area are set and proposed for carefully controlled animal investigation before cautious application in humans are made.

Original languageEnglish (US)
Pages (from-to)272-277
Number of pages6
JournalGastroenterology
Volume70
Issue number2
StatePublished - 1976

Fingerprint

Gastrointestinal Hemorrhage
Endoscopes
Vasopressins
Hemorrhage
Balloon Occlusion
Antacids
Mortality
Emergencies
Esophageal and Gastric Varices
Hyponatremia
Asphyxia
Bacteremia
Research
Ulcer
Cardiac Arrhythmias
Early Diagnosis
Veins
Thrombosis
Necrosis
Arteries

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Experimental control of gastrointestinal hemorrhage via the endoscope : a new era dawns. / Katon, Ronald.

In: Gastroenterology, Vol. 70, No. 2, 1976, p. 272-277.

Research output: Contribution to journalArticle

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