Hemostasis by Capping Bleeding Diverticulum of the Colon with Clips

Yoshikane, Hiroaki; Sakakibara, Akira; Ayakawa, Tadao; Watanabe, M; Hashimoto, Shuji; Mori, S; Hidano, Hitoshi

doi:10.1055/s-2007-1004243

Cited by 22 publications

(8 citation statements)

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“…However, the practice of early colonoscopy requires experienced endoscopists, in whose hands diagnosis is achieved in 70-80% of cases with few complications (16). On the other hand, this technique can be used as a therapeutic one (16,19) with relatively good results, as in our series, although there are risks of complications such as intestinal perforation, (19,20). It is necessary to remember that there are authors who consider colonoscopy not to be a useful therapeutic diagnostic tool, such as Angtuaco et al (21), who comment that LGIH generally has a spontaneous resolution and has a good prognosis independent of whether or not the colonoscopy is urgent.…”

Section: Discussionmentioning

confidence: 61%

Acute Lower Gastrointestinal Hemorrhages in Geriatric Patients

et al. 2005

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Age is a risk factor in acute lower gastrointestinal hemorrhages (LGIH). The objectives here were to analyze: (1) diagnostic and therapeutic handling, (2) related morbidity and mortality, (3) the indications for surgery, and (4) the evolution of acute LGIH in patients > or =80 years. Forty-three patients >80 years with acute LGIH were reviewed retrospectively. In 86% (n = 37) related comorbidities were found, in 9% (n = 4) there had been prior colorectal surgery, 19% (n = 8) were antiaggregated, and 7% (n = 3) were anticoagulated. One hundred thirty-two cases of acute LGIH in patients <80 years were used as a control group. Student's t test and the chi-square test were applied. On arrival at the emergency ward 11 cases (26%) had hemodynamic instability and 8 of these were stabilized using conservative measures. In 39 cases an endoscopy was performed, allowing for an etiological diagnosis in 59% (n = 23) of cases, above all in those carried out in an urgent or semiurgent way. The arteriography permitted an etiological diagnosis in two of the four cases in which it was carried out. In seven patients (16%) urgent surgery was indicated: three were hemorrhoidectomies, three were subtotal colectomies, and one was a resection of the small intestine. The morbidity rate was 10% (n = 4) in the patients who were not treated and 14% (n = 1) in those treated, with a mortality rate of 8% (n = 3) and 14% (n = 1), respectively. The rate of relapse of bleeding after discharge from hospital was 42% (n = 18), with nine of these needing to be readmitted into hospital. In comparison with the control group, they present a different bleeding etiology (diverticulosis as opposed to the benign anal-rectal and small intestinal pathology in the younger population; P = 0.017), surgery is indicated with less frequency (9 versus 33%; P = 0.007), and there is a higher relapse rate (42 versus 26%; P = 0.045). Acute LGIH in geriatric patients relents in most cases with the use of conservative measures, although there is a high percentage of related morbidity and mortality, and of relapse of bleeding.

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Section: Discussionmentioning

confidence: 61%

Acute Lower Gastrointestinal Hemorrhages in Geriatric Patients

et al. 2005

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“…An advantage of its early use is that this technique can be used as a therapy [14,16] with relatively good results [14,16,17]. However, early colonoscopy has some disadvantages [18], and not all authors agree with our findings [19].…”

Section: Discussionmentioning

confidence: 69%

Severe acute lower gastrointestinal bleeding: risk factors for morbidity and mortality

Rı́os

Montoya

Rodrı́guez

et al. 2006

Langenbecks Arch Surg

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It is difficult to predict which patients are going to need urgent surgery in severe acute LGIB; only the presence of hypotension on arrival at the emergency ward would lead us to suspect a negative outcome for the hemorrhage. In severe acute LGIB, morbidity and mortality is high, and this is mainly due to the high level of associated comorbidity and the need for urgent surgery. It is necessary for strict hemodynamic monitoring of the patients at risk if we want to improve outcomes. The bleeding relapse rate is high in LGIB, although generally, it is not severe.

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“…Mucosal clipping in the colon has been used for various purposes: to mark out clinically significant areas during colonoscopy,22 treatment of colonic diverticular bleeding23,24 and treatment of small colonic perforations 25. Endoclips have also been used to secure feeding tubes and esophageal prosthesis 26,27.…”

Section: Discussionmentioning

confidence: 99%