Endoscopic control of gastrointestinal hemorrhage by local injection of absolute ethanol: A basic assessment of the procedure.

Asaki, Shigeru; Nishimura, Toshiaki; Satoh, Akira; Gotō, Yoshio

doi:10.1620/tjem.140.339

Cited by 23 publications

(6 citation statements)

References 7 publications

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“…Under these circumstances, endoscopic hemostasis has become the most adequate treatment for the ulcer bleeding. As shown in Table 3, several endoscopic hemostatic procedures [1][2][3][4][5][6][7][8][9] have been used. It has been reported that these endoscopic hemostasis techniques had a success rate of about 90% or more.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Endoscopic Pure Ethanol Injection Method for Gastrointestinal Ulcer Bleeding

Asaki

2000

World j. surg.

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We reviewed endoscopic hemostatic effects of the pure ethanol injection (PEI) method for reducing emergency operations and deaths due to gastroduodenal ulcer bleeding. During 17 years beginning in June 1979 in Tohoku University Hospital, 331 patients underwent endoscopic hemostasis by the PEI method. Initial hemostasis was successfully obtained in all cases. Rebleeding occurred in about 4% of the patients, and rehemostasis was obtained successfully in all of them. Complete hemostasis was obtained in 330 of 331 patients (99. 7%) using the PEI method; there were no deaths. Only one patient required emergency operation after hemostasis because of repeated neogenetic bleeding complicated with a perforation and another because of an unidentifiable neogenetic ulcer bleeding located just above the Vater papilla. None required other endoscopic hemostasis or interventional radiology. Moreover, after introduction of "second-look" endoscopy, the rebleeding rate decreased to about 1% with PEI hemostasis. Based on these excellent hemostatic effects of the PEI method, we believe that a comparative study with other hemostatic methods is not needed.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Endoscopic Pure Ethanol Injection Method for Gastrointestinal Ulcer Bleeding

Asaki

2000

World j. surg.

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“…Although the results with sclerosants in uncontrolled clinical studies are impressive, the ulcerogenic potential of these substances is worrying; ulcers have been shown to grow bigger and healing to be retarded with large 3 3 2 2 NS volumes of laureth 9,3 and in another study one patient died of a perforated ulcer when alcohol was used. 1 In clinical trials on gastrointestinal bleeding various end points can be used to determine the success or otherwise of treatment. 24 The most unequivocal end point is death.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial

Chung

Leung²,

Steele³

et al. 1988

BMJ

210

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A prospective randomised trial was performed to assess the efficacy of endoscopic injection of adrenaline for actively bleeding ulcers. Emergency endoscopy in 961 patients admitted for upper gastrointestinal haemorrhage identified 68 patients with actively bleeding ulcers. These 68 patients were randomised to receive either endoscopic injection of adrenaline or no endoscopic treatment. After endoscopy both groups were managed in an identical manner, and strict criteria for emergency operation were adhered to in both groups. Bleeding was initially controlled in all 34 patients assigned to the treatment group. Significantly fewer patients in the treatment group than in the control group needed emergency operations (five v 14, respectively). In addition, in the treatment group the median transfusion requirement was significantly less (three v five units of blood) and the median hospital stay shorter (six v eight days). No complications were observed with the injection of adrenaline, and the rate of healing of ulcers in those attending for endoscopy six weeks after discharge was similar in both groups (81% (17 out of 21 patients) in the treatment group v 79% (11 out of 14) in the control group). Injection of adrenaline is effective in stopping bleeding from actively bleeding ulcers.

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“…Substitution of hypertonic saline prolongs the action of the epinephrine, as well as adding tissue effects of the hypertonicity, including tissue swelling, fibrinoid degeneration of the vessel wall, and thrombosis of the vessel lumen [26]. The injection of absolute alcohol (used in much smaller volumes) effects hemostasis by dehydration and fixation of the exposed blood vessel wall and surrounding tissue, resulting in vasoconstriction, vessel wall degeneration, endothelial cell destruction, and ultimate thrombosis [27]. The addition of thrombin to saline initially stops bleeding by volume tamponade, and then by activation of clotting and fibrin formation [28].…”

Section: Injection Methodsmentioning

confidence: 99%

Endoscopic management of nonvariceal gastrointestinal bleeding

Steffes

Sugawa

1992

World j. surg.

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Endoscopic management of upper gastrointestinal bleeding has been expanded from a purely diagnostic role to a therapeutic role in many patients. In addition to controlling active bleeding, it is an option in a patient who is clinically at a high risk of rebleeding, or in patients who have peptic ulcers with visible vessels or stigmata indicating high risk. Several methods have been studied, and currently the most useful include thermal cautery with the heater probe or bipolar electrocoagulation, and injection using epinephrine and/or sclerosants. Endoscopic hemostasis can effect permanent control of bleeding in many patients, but should be considered complementary to conventional surgical control in other patients, where temporary control to stabilize the patient is a desired end.

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Endoscopic control of gastrointestinal hemorrhage by local injection of absolute ethanol: A basic assessment of the procedure.

Cited by 23 publications

References 7 publications

Efficacy of Endoscopic Pure Ethanol Injection Method for Gastrointestinal Ulcer Bleeding

Efficacy of Endoscopic Pure Ethanol Injection Method for Gastrointestinal Ulcer Bleeding

Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial

Endoscopic management of nonvariceal gastrointestinal bleeding

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