Effectiveness of Endoscopic Hemostasis with Soft Coagulation for Non-Variceal Upper Gastrointestinal Bleeding over a 12-Year Period

Abstract

Background/Aims: In this study, investigations were carried out to ascertain whether soft coagulation hemostasis for non-variceal upper gastrointestinal bleeding (UGIB) has ever been performed in a time-dependent manner. Methods: Medical records of 502 patients who had undergone emergency endoscopic hemostasis for non-variceal UGIB from 2003 to 2014 were checked and the modalities were used to achieve hemostasis compared between the first period from 2003 to 2008 (197 patients) and the second period from 2009 to 2014 (305 patients). Results: Endoscopic hemostasis was successfully achieved in 96.0% of study patients. Peptic ulcers were the main cause of bleeding (89.4%). Endoscopic hemostasis was performed by soft coagulation significantly more frequently during the second (71.1%) than the first period (11.7%; p < 0.001). Endoscopic hemostasis was mainly achieved by trainees during the second period (76.1%); these trainees comprised a significantly greater proportion of endoscopists than during the first period (56.3%; p < 0.001). Endoscopic-related complications did not differ between the 2 periods. The only risk factor for rebleeding after hemostasis was Helicobacter pylori infection; the use of soft coagulation and the fact that endoscopists were just trainees were not risk factors. Conclusion: Our findings suggest that using soft coagulation to achieve endoscopic hemostasis for non-variceal UGIB is safe and effective, even when it is performed by trainees.

High Cost of Hospitalization for Colonic Diverticular Bleeding Depended on Repeated Bleeding and Blood Transfusion: Analysis with Diagnosis Procedure Combination Data in Japan

“…Colonoscopy is applied for both diagnosis and treatment of colonic diverticular bleeding. Clipping, endoscopic band ligation, injection therapy, and contact thermal therapy are available methods for endoscopic hemostasis [11,12]. …”

Outcomes of Patients Undergoing Endoscopic Hemostasis for the Upper Gastrointestinal Bleeding Were Not Influenced by the Timing of Hospital Emergency Visits: A Situation Prevailing in Japan

“…However, hospitalized patients undergoing endoscopic hemostasis are more likely to experience worse outcomes than outpatients, mainly because of their bad general condition. Data was collected from patients treated from 2008 to 2014, a time of changing trends in the endoscopic treatment of upper gastrointestinal bleeding [2]; these differences warrant further exploration.…”

“…The outpatients were further classified into 2 subgroups: those who visited the hospital emergency unit during regular hours (08: 30 to 17: 00 on weekdays; n  = 120) and those who visited the hospital emergency unit during off hours (17: 00 to 8: 30 on weekdays or on weekends/holidays; n  = 187). Hemostasis was achieved in all patients in the present study with endoscopic maneuvers including hemoclip application, pure ethanol injection and/or electrocoagulation, as previously described [1, 2, 11-13]. After endoscopic hemostasis, all patients were hospitalized and managed with conventional therapies, including nil oral intake, intravenous fluids and acid secretion inhibitors.…”

“…Emergency endoscopic hemostasis is the primary therapeutic approach to upper gastrointestinal bleeding, which is a serious life-threatening condition [1, 2]. Several studies in Western countries have indicated a “weekend effect” in therapeutic outcomes of endoscopic hemostasis in patients with upper gastrointestinal bleeding: those treated during off hours had a worse prognosis than those treated during regular hours [3-6].…”

Safety and Efficacy of the Non-Cessation Method of Antithrombotic Agents After Emergency Endoscopic Hemostasis in Patients with Non-Variceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study

“…Non-variceal upper gastrointestinal bleeding (UGIB) is one of the most common causes of gastrointestinal emergencies, sometimes requiring emergency endoscopic hemostasis. While Helicobacter pylori (H. pylori) infection and nonsteroidal anti-inflammatory drugs are the two main causes of hemorrhagic peptic ulcer disease [1][2][3][4][5], an alteration in the epidemiology and pathophysiology of UGIB has been recently suggested because of the decreasing prevalence of H. pylori infection as well as the increasing use of antithrombotic agents [6,7].…”