Endoclips<i>vs</i>large or small-volume epinephrine in peptic ulcer recurrent bleeding

Ljubičić, Neven; Budimir, Ivan; Bišćanin, Alen; Nikolić, Marko; Supanc, Višnja; Hrabar, Davor; Pavić, Tajana

doi:10.3748/wjg.v18.i18.2219

Cited by 21 publications

(14 citation statements)

References 14 publications

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“…Although epinephrine injection is effective in achieving initial hemostasis in patients with active ulcer bleeding, the rebleeding rate is reported to be 12-30%. [91][92][93][94][95] Epinephrine plus a second hemostatic method can be expected to reduce the rate of rebleeding compared to epinephrine alone. [96][97][98] Furthermore, epinephrine injection can diminish or stop bleeding, improving endoscopic visualization for a second hemostatic method, and pre-injection of epinephrine can reduce the rate of severe bleeding induced by removal of adherent clots.…”

Section: Choice Of Endoscopic Hemostatic Methodsmentioning

confidence: 99%

“…Endoscopic hemostasis for bleeding peptic ulcer is more effective than no endoscopic therapy in reducing further bleeding and the need for surgery. Although epinephrine injection is effective in achieving initial hemostasis in patients with active ulcer bleeding, the rebleeding rate is reported to be 12–30% . Epinephrine plus a second hemostatic method can be expected to reduce the rate of rebleeding compared to epinephrine alone .…”

Section: Management Of Patients With Acute Peptic Gastroduodenal Ulcementioning

confidence: 99%

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Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Fujishiro

Iguchi

Kakushima

et al. 2016

Digestive Endoscopy

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Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding using evidence‐based methods. The major cause of non‐variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug‐related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)‐related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first‐line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research.

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Section: Choice Of Endoscopic Hemostatic Methodsmentioning

confidence: 99%

Section: Management Of Patients With Acute Peptic Gastroduodenal Ulcementioning

confidence: 99%

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Fujishiro

Iguchi

Kakushima

et al. 2016

Digestive Endoscopy

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“…Europa als Standard betrachtet werden. Es existieren Hinweise für die Überlegenheit der Clip-Applikation gegenüber der Injektionstherapie [15,16]. Clips eignen sich besonders für Ulkusblutungen aus sichtbaren Gefäßstümpfen.…”

Section: Mechanische Verfahrenunclassified

Management gastrointestinaler Blutungen unter Antikoagulation

2020

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ZUSAMMENFASSUNGDie endoskopische Therapie bei gastrointestinalen Blutungen ist hoch effektiv und sicher, auch unter Einnahme von Antikoagulanzien. Das technische Vorgehen unterscheidet sich nicht vom Vorgehen bei fehlender Einnahme von Antikoagulanzien, wobei z. B. der Stellenwert einer primären OTSC („over-the-scope clip“, Ovesco Endoscopy)-Applikation bei Hochrisikopatienten noch untersucht werden muss. Das Management der Antikoagulation unterscheidet sich zwischen den unterschiedlichen Präparaten und der zugrundeliegenden Indikation und muss dem individuellen Risiko angepasst werden. Thrombozytenaggregationshemmer sollten maximal für die Intervention pausiert und früh wieder verabreicht werden. Das Management unter dualer Plättchenhemmung oder Triple-Therapie ist zwingend interdisziplinär abzusprechen. Bei Niedrigrisikosituation kann die duale Therapie in der Regel fortgeführt werden. Bei vitaler Blutung unter Vollantikoagulation ist eine Antagonisierung empfohlen, bei nicht vitaler Blutung ist diese abhängig vom endoskopischen Erfolg. Die Vollantikoagulation sollte frühestmöglich, in der Regel nach ca. 7 Tagen, wieder aufgenommen werden (Ausnahmen: mechanische Herzklappen, frisch implantierte Bioklappen, sehr hohes Thromboembolierisiko).

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“…Currently, hemoclipping is considered a safe and effective alternative for controlling hemostasis in non-variceal bleeding episodes within the GI tract [139,140,141,142,143], offering also the great benefit of not affecting the healing processes. There are many hemoclip models on the market, for instance, the following (the brand names may actually be followed by trademark symbols ( ® , ™): EZ clips, hemoclips HX-600/610/200, QuickClip, QuickClip2 (Olympus Medical Corp, Tokyo, Japan or Olympus America Inc, Lombard, IL, USA); TriClip, Instinct (Cook Endoscopy/Cook Medical, Bloomington, IN, USA); Resolution clip (Boston Scientific, Rolling Meadows, IL, USA); MultiClip Applier (InScope/Ethicon, Blue Ash, OH, USA); OTSC (Ovesco, Tubingen, Germany); DuraClip (Conmed, Edison, NJ, USA).…”

Section: Clipping For Endoscopic Control Of Bleedingmentioning

confidence: 99%

Biomaterials in Gastroenterology: A Critical Overview

Goldiş

Goldis²,

Chirilă

2019

Medicina

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In spite of the large diversity of diagnostic and interventional devices associated with gastrointestinal endoscopic procedures, there is little information on the impact of the biomaterials (metals, polymers) contained in these devices upon body tissues and, indirectly, upon the treatment outcomes. Other biomaterials for gastroenterology, such as adhesives and certain hemostatic agents, have been investigated to a greater extent, but the information is fragmentary. Much of this situation is due to the paucity of details disclosed by the manufacturers of the devices. Moreover, for most of the applications in the gastrointestinal (GI) tract, there are no studies available on the biocompatibility of the device materials when in intimate contact with mucosae and other components of the GI tract. We have summarized the current situation with a focus on aspects of biomaterials and biocompatibility related to the device materials and other agents, with an emphasis on the GI endoscopic procedures. Procedures and devices used for the control of bleeding, for polypectomy, in bariatrics, and for stenting are discussed, particularly dwelling upon the biomaterial-related features of each application. There are indications that research is progressing steadily in this field, and the establishment of the subdiscipline of “gastroenterologic biomaterials” is not merely a remote projection. Upon the completion of this article, the gastroenterologist should be able to understand the nature of biomaterials and to achieve a suitable and beneficial perception of their significance in gastroenterology. Likewise, the biomaterialist should become aware of the specific tasks that the biomaterials must fulfil when placed within the GI tract, and regard such applications as both a challenge and an incentive for progressing the research in this field.

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Endoclipsvslarge or small-volume epinephrine in peptic ulcer recurrent bleeding

Abstract: Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.

Cited by 21 publications

References 14 publications

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Management gastrointestinaler Blutungen unter Antikoagulation

Biomaterials in Gastroenterology: A Critical Overview

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