Heveny gastrointestinalis vérzések ellátása. Multidiszciplináris útmutató javaslat

Gyökeres, T; Schäfer, Eszter; Szepes, Attila; Vitális, Zsuzsanna; Papp, Mária; Altorjay, István; Czakó, László; Vincze, Áron; Bursics, Attila; Kanizsai, Péter; Berényi, Tamás

doi:10.1556/650.2020.31807

Cited by 4 publications

(18 citation statements)

References 46 publications

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“…[20] It is indicated in patients with re-bleeding or hemodynamic instability despite fluid therapy and blood transfusion. [21] Emergency surgery is currently only suitable for perforations, patients who fail non-surgical therapy, and those who remain hemodynamically unstable despite aggressive resuscitation. [22] In our study, emergency surgical intervention was performed in patients whose bleeding could not be controlled by endoscopic intervention and those who did not accept endoscopic intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is recommended if bleeding cannot be controlled by endoscopy and embolization/arteriography, or if there is no interventional radiologist after a failed endoscopic procedure [20] . It is indicated in patients with re-bleeding or hemodynamic instability despite fluid therapy and blood transfusion [21] . Emergency surgery is currently only suitable for perforations, patients who fail non-surgical therapy, and those who remain hemodynamically unstable despite aggressive resuscitation [22] .…”

Section: Discussionmentioning

confidence: 99%

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Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding

Akay

Leblebici

2021

Medicine

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Peptic ulcer disease accounts for 50% to 70% of acute upper gastrointestinal bleeding cases. There is no consensus on the treatment of peptic ulcer bleeding (PUB) using endoscopic techniques. This study aimed to compare endoscopic techniques for PUB. Patients with PUB who were hospitalized between January 2014 and June 2020 were included in this study. They were divided into 3 groups: endoclip and low-dose epinephrine injection (0–2 mg, Group 1, n = 62), endoclip and high-dose epinephrine injection (2–4 mg, Group 2, n = 54), and endoclip only (Group 3, n = 64). Early bleeding and permanent hemostasis were higher in Group 2 ( P = .014, .035). When evaluated in terms of late hemostasis and urgent surgical need, there was no significant difference between the groups ( P > .05). Group 2 received a higher amount of blood. Thirty-day mortality occurred in 16.5%, 22.2%, and 9.4% of patients in Groups 1, 2, and 3, respectively. Group 2 had a longer hospital stay than Groups 1 and 3 ( P = .008). The endoscopic success rates were 80.6%, 72.2%, and 90.6% in Groups 1, 2, and 3, respectively. In PUB, if the patient's Rockall score is high and the ulcer size is larger than 2 cm, endoclip application can be used as the main treatment. Addition of epinephrine may be considered when necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding

Akay

Leblebici

2021

Medicine

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“…Az akut gastointestinalis vérző beteg ellátása multidiszciplináris művelet, melynek résztvevői: SBO, gasztroenterológiai endoszkópia és szakmaspecifikus őrző, esetenként intenzív terápiás osztály, invazív radiológia és sebészet [12].…”

Section: öSszefoglaló Közleményunclassified

“…A kockázatfelmérés alapján eldönthető az endoszkópia időzítése, és prognosztizálható az esetleges hazabocsátás lehetősége. A számos validált rizikóbecslési módszer közül az ESGE-ajánlás és a hazai útmutatók egyaránt a Glasgow-Blatchford Score (GBS) használatát javasolják [11,12,19]. A GBS csak klinikai tünetek (vérnyomás, pulzus, melaena, eszméletvesztés, máj-és szívbetegség) és laborparaméterek (karbamid-nitrogén, hemoglobin) értékelésén alapul.…”

Section: Preendoszkópos Diagnosztikaunclassified

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Az akut gastroduodenalis fekélyvérzés gyógyszeres és endoszkópos kezelésének újabb szempontjai

Rácz

2023

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Az akut gastroduodenalis fekélyvérzés kórházi ellátást és több szakma összefogását igénylő életveszélyes állapot. A kezelési program felöleli a keringést stabilizáló sürgősségi ellátást, a szakszerű transzfundálást, a savszekréció-gátló terápiát, az endoszkópos diagnosztikát és kezelést, továbbá esetenként az invazív radiológiai és a sebészeti beavatkozást is. Az újabb ajánlások csupán megfontolásra ajánlják, de nem javasolják a preendoszkópos nagy dózisú parenteralis protonpumpagátló kezelést. A sürgős (≤12 óra) endoszkópia klinikailag nem előnyösebb a korai (≤24 óra) endoszkópiánál. Nagy újravérzési kockázatú, a 2 cm-es átmérőt elérő fibroticus alapú és 2 mm-nél nagyobb ércsonkos vérző fekélyek „over-the-scope clip” kezelése már első vonalbeli kezelésként is ajánlott. Új terápiás lehetőség az endoszkópos vérzéscsillapítás utáni, intermittálóan adagolt parenteralis protonpumpagátló kezelés. A tervezett ellenőrző endoszkópiák programszerűen nem ajánlottak, de magas újravérzési kockázatú fekélyvérzőkben egyéni mérlegelés után tanácsosak. Gastroduodenalis fekélyvérzőkben a primer cardiovascularis profilaxis célú, kis dózisú aszpirin elhagyása indokolt, de a szekunder megelőzésként végzett aszpirinkezelés folytatható. Orv Hetil. 2023; 164(23): 883–890.

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Main reasons and predictive factors of cancer-related emergency department visits in a Hungarian tertiary care center

et al. 2022

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Background Identifying the reasons for the Emergency Department (ED) visit of patients with cancer would be essential for possibly decreasing the burden of ED use. The aim of our study was to analyze the distribution of the demographic and clinical parameters of patients with cancer based on the reasons for the ED visits and to identify possible predictive factors for their visits. Methods This retrospective study, carried out at a large, public tertiary hospital in Hungary, involved all patients 18 years or over, who had received a cancer diagnosis latest within five years of their visit to the ED in 2018. Demographic and clinical characteristics were collected partly via automated data collection and partly through the manual chart review by a team of experts, including six emergency physicians and an oncologist. Five main reasons for the ED visit were hypothesized, pilot-tested, then identified, including those with cancer-related ED visits (whose visit was unambiguously related to their cancer illness) and those with non-cancer-related ED visits (whose visit to the ED was in no way associated with their cancer illness.) A descriptive approach was used for data analysis and binary logistic regression was used to determine predictive factors for patients with cancer visiting the ED. Results 23.2% of the altogether 2383 ED visits were directly cancer-related, and these patients had a significantly worse overall survival than patients with non-cancer related ED visits. Age 65 or below (Odds Ratio: 1.51), presence of two more comorbidities (OR: 7.14), dyspnea as chief complaint (OR: 1.52), respiratory cancer (OR: 3.37), any prior chemotherapy (OR: 1.8), any prior immune/biological treatment (OR: 2.21), any prior Best Supportive Care/palliative care (OR: 19.06), or any prior hospice care (OR: 9.43), and hospitalization (OR:2.88) were independent risk factors for the ED visit to be cancer-related. Conclusions Our study is the first to identify independent predictive factors of ED use by patients with cancer based on the chief cause of their visit in the Central and Eastern European region. These results may provide important information for the development of algorithms intended to identify the needs of care of patients with cancer at the ED.

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Heveny gastrointestinalis vérzések ellátása. Multidiszciplináris útmutató javaslat

Cited by 4 publications

References 46 publications

Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding

Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding

Az akut gastroduodenalis fekélyvérzés gyógyszeres és endoszkópos kezelésének újabb szempontjai

Main reasons and predictive factors of cancer-related emergency department visits in a Hungarian tertiary care center

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