Author/Editor		Gorenšek, Milan
Title		Vpliv odstranjevanja krvnega strdka pri peptični razjedi na učinkovitost injekcijske skleroterapije
Translated title		Influence of clot removal on the success of injection sclerotherapy in peptic ulcer
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 4, št. 10
Publication year		1999
Volume		str. 145-53
Language		slo
Abstract		Background. Bleeding from GI ulcerations can be controlled by endoscopic treatment carried out at the time of diagnostic endoscopy. In patients with peptic and duodental ulcer, the risk of exsanguination or recurrent hemorrhage was eliminated by clot removal and endoscopic hemostasis. Our prospective controlled study involved 415 patients aged 17 to 96 years, who were divided into groups by the modified Forrest's classification (F), and further into subgroups with respect to the extend of clot removal. Each group and subgroup was studied separately. Bleeding peptic ulcerations were managed endoscopically by means of combination injection sclerotherapy (IS) according to Soehendra. IS was emplyed uniformly in all patients regardless of whether they had their clots removed or not. Results. Of the 415 patients included in the study, 262 (63.1%) had their clots removed whatever their location. IS proved unsuccessful in merely 2.7% of patients undergoing clot removal, compared to the failure rate 16.4% in patients who had no clot removal prior to IS. The difference between the two groups was statistically significant (p = 0.0000069). Clots were successfully removed in 126 (63%) of the 200 patients classiiified as FIc (bleeding from a lession covered with an adherent clot). In this group, the final success rate of IS was 97.6%, while in a group of 52 patients with clots left in site iy was 78.8%. The difference between both groups was statistically significant (p= 0.0000098). In grade F IIb group, comparising 215 patients, clot removal was accomplished in 136 patients (63.3%) with a final success rate of 97.1%, which differed significantly from the final success rate of 87.9% obtained in 58 patients undergoing no clot removal (p=0.0182). Conclusions. The final success rate of IS in 415 patients was 93.0%, this slightly smaller total figure being attributable to the lower final success rate of treatment in cases with unremoved clots (85.6%). Abstract truncated at 2000 char.
Summary		Izhodišča. Z endoskopsko terapevtskim posegom lahko endoskopist ob diagnosticiranju krvaveče razjede spremeni potek krvavitve. Pri peptični razjedi želodca in dvanajstnika smo adherentne strdke zaradi nevarnosti izkrvavitve ali ponovne krvavitve odstranjevali in izvedli endoskopsko hemostazo. Bolniki in metoda. V prospektivno kontrolirano preiskavo smo vklučili 415 bolnikov, starih od 17 do 96 let. Razvrstili smo jih v skupine modificirane Forrestove (F) klasifikacije, poleg tega pa še v podskupine, glede na stopnjo odstranitve strdka na peptični razjedi. Vsako skupino in podskupino smo analizirali posebej. Za endoskopsko zdravljenje krvavečih peptičnih razjed smo uvedli kombinirano injekcijsko skleroterapijo (IS) po Soehendri. Pri vseh bolnikih z odstranjenim ali neodstranjenim strdkom smo izvšili injekcijsko skleroterapijo. Rezultati. Od 415 bolnikov vključenih v študijo smo strdek odstranili ne glede na lokalizacijo pri 262 bolnikih (63,1%). IS je bila neuspešna le v 2,7%, pri bolnikih z neodstranjenim strdkom pa v 16,4%. Razlika v uspešnosti je statistično značilna (p=0,0000068). Pri 200 bolnikih z F Ic (modificirana razvrstitev krvavitev po Forrestu - krvavitev izpod adherenskega strdka) smo pri 126 bolnikih (63%) strdek odstranili. Po IS je bila končna uspešnost 97,6-odstotna. Razlika je v primerjavi z neodstranjenimi strdki (52 bolnikov) s 78,8-odstotno končno uspešnostjo statistično značilna (p=0,000098). Pri F IIb (215 bolnikov) smo strdek odstanili pri 136 bolnikih (63,3%); končna uspešnost je bila 97,1-odstotna. Razlika je v primerjavi z neodstranjenimi strdki (58 bolnikov) s 87,9-odstotno končno uspešnostjo statistično značilna (p=0,0182). Zaključki. Končni uspeh IS pri 415 bolnikih je bil 93,0-odstoten. Zmanjševali so ga predvsem neodstranjeni adherentni strdki (s končnim uspehom 85,6%). Če bi upoštevali samo bolnike z odstranjenimi strdki, bi bil uspeh 97,3-odstoten. (Izvleček prekinjen pri 2000 znakih.)
Descriptors		HEMOSTASIS, ENDOSCOPIC PEPTIC ULCER HEMORRHAGE CLOT RETRACTION SCLEROTHERAPY