2012-9-27 Endoscopic hemostasis Radiological therapy a Highly-selective coil embolization for tion therapy using epinephrine or other sclerosants bleeding ulcer and vascular malforn lation atin sponge pledgets hageal varices ligation using single or multiple band ligators Polyvinyl alcohol particles cyanoacrylate for gastrie varices a Trans-jugular Intrahepatic Portal-Systemic ormation Shunts (TIPss) for gastric or esophageal Hemostatic clips Surgery common causes of acute GI bleeding urgery remains the most definitive method ding that cannot be controlled by fusion(i.e total of 6-8 units of blood Evidence suggestive of GI perfora GI Bleeding Case G,I, Bleeding Case ■58-year-0 BP 130/80mmHg HR 100 beats/min a Black unformed stools, nausea cated BP 100/80mmHg, HR 120 beats/ min epigastric pain. n HEENT: funduscopic examination shows arterial s 10 years ago he had an ulcer Chest: clear He has a daily alcohol intake of two bears s Extremities: no cyanosis or edema. He has been taking one enteric-coated m Stool: melenic, fecal occult blood test positive. aspirin each day.2012-9-27 4 www.zshospital.com Hong Shi, Department of Gastroenterology & Hepatology, Zhongshan Hospital 复 旦 大 学 附 属 中 山 医 院 消 化 科 Endoscopic hemostasis  For peptic ulcers (either actively bleeding or showing protuberant vessel or fresh clot) – injection therapy using epinephrine or other sclerosants – thermocoagulation using heater probe or electrocoagulation – Hemostatic clips  For gastric or esophageal varices – Injection of sclerosant (ethanolamine, STD) – Banding ligation using single or multiple band ligators – Injection of cyanoacrylate for gastric varices  For vascular malformation – Argon plasma coagulation – Hemostatic clips www.zshospital.com Hong Shi, Department of Gastroenterology & Hepatology, Zhongshan Hospital 复 旦 大 学 附 属 中 山 医 院 消 化 科 Radiological therapy  Highly-selective coil embolization for bleeding ulcer and vascular malformation using: – Gelatin sponge pledgets – Micorcoils – Polyvinyl alcohol particles  Trans-jugular Intrahepatic Portal-Systemic Shunts (TIPSS) for gastric or esophageal varices www.zshospital.com Hong Shi, Department of Gastroenterology & Hepatology, Zhongshan Hospital 复 旦 大 学 附 属 中 山 医 院 消 化 科 Surgery  Surgery remains the most definitive method of stopping hemorrhage.  Indications – Arterial bleeding that cannot be controlled by endoscopic haemostasis. – Massive transfusion (i.e. total of 6-8 units of blood) required to maintain blood pressure. – Recurrent clinical bleeding after initial success in endoscopic and/or angiographic hemostasis – Evidence suggestive of GI perforation www.zshospital.com Hong Shi, Department of Gastroenterology & Hepatology, Zhongshan Hospital 复 旦 大 学 附 属 中 山 医 院 消 化 科 Algorithm in the management of common causes of acute GI bleeding www.zshospital.com Hong Shi, Department of Gastroenterology & Hepatology, Zhongshan Hospital 复 旦 大 学 附 属 中 山 医 院 消 化 科 G.I. Bleeding Case  58-year-old man  Black unformed stools, nausea, epigastric pain.  10 years ago he had an ulcer.  He has a daily alcohol intake of two bears.  He has been taking one enteric-coated aspirin each day. www.zshospital.com Hong Shi, Department of Gastroenterology & Hepatology, Zhongshan Hospital 复 旦 大 学 附 属 中 山 医 院 消 化 科 G.I. Bleeding Case  Vital signs – Supine BP 130/80mmHg, HR 100 beats/min – Seated BP 100/80mmHg, HR 120 beats/min  HEENT: funduscopic examination shows arterial narrowing  Chest: clear  Abdomen: active bowel sounds, no masses or tenderness, spleen is not palpables.  Extremities: no cyanosis or edema.  Stool: melenic, fecal occult blood test positive