Üst gastrointestinal sistem kanamalarında sıcak forseps ile hemoklip uygulamalarının retrospektif karşılaştırılması
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Üst gastrointestinal kanama (ÜGİK), doktorlar tarafından en sık karşılaşılan acil durumlardan biridir. Yıllık insidans 100.000'de 133'tür. Peptik ülser hastalığı, tüm vakaların %31 ila %67'sinden sorumludur ve ÜGİK'nin en yaygın nedenidir. Bunun yanında diğer nedenler varis kanaması, eroziv hastalıklar, Mallory-Weiss yırtığı, Dieulafoy lezyonları, vasküler ektazi ve malignite olarak sıralanabilir. Tedavi genellikle asit baskılama ve endoskopik yöntemlerin kullanımına dayanır. ÜGİK tedavisinde kullanılabilecek endoskopik teknikler; enjeksiyon tedavisi, termal pıhtılaşma tedavisi, hemostatik klipsler, fibrin örtücü, argon plazma pıhtılaştırması ve bu sayılan tekniklerin herhangi biri ile epinefrin enjeksiyonu kombinasyonu yer almaktadır. Bununla birlikte, hangi yöntemin en iyi olduğuna ve seçim yöntemini oluşturması gerektiğine dair net bir kanıt yoktur. Endoskopistin kişisel tercihi, mevcut ekipman, lezyonun yeri ve özellikleri tedavi seçiminde rol oynar. Endoskopik HC, ÜGİK tedavisinde sıklıkla kullanılan mekanik bir tekniktir. Bu mekanik aparat kanayan lezyona ve periferik dokuya tutunarak tamponad ve hemostaz sağlar. Termal tedaviler ise vasküler yapılarda koagülasyon nekrozu ile daralma yaparak hemostaz sağlar. Üç ana tip termal temas cihazı vardır; çok kutuplu sondalar, ısıtıcı sondalar ve monopolar sondalar. Düşük maliyetli olan sıcak forseps (HF), monopolar hemostatik forsepse benzer şekilde çalışır. HF özellikle polipektomide ve endoskopik submukozal diseksiyonda (ESD) hemostaz sağlanmasında faydalıdır. Çalışmamızda ÜGİK tedavisinde HC ve HF'nin etkinliği ve maliyet etkinliğinin retrospektif karşılaştırmasını yaptık. Gereç ve Yöntem: Çalışma, Düzce Üniversitesi Eğitim Araştırma Hastanesi Gastroenteroloji ve İç Hastalıkları Anabilim Dalı'nda; Haziran 2017-Mart 2022 tarihleri arasında Gastroenteroloji ve İç Hastalıkları polikliniklerine başvuran hastalarla gerçekleştirildi. Hastalar araştırmaya katılmaya gönüllü olanlardan seçildi ve yazılı bilgilendirilmiş onam formu alındı. Üst gastrointestinal sistem kanaması olan hastalara endoskopi sırasında gereği halinde sıcak forseps veya hemoklip uygulamaları rutin olarak yapılmaktadır. Hastalar uygulanan endoskopik hemostatik yönteme göre iki gruba ayrıldı. HF grubu, sıcak forseps koagülasyon, HC grubu ise hemoklips uygulanan kişilerden seçildi. Primer hemostaz oranları, tekrarlayan kanama, transfüzyon gereksinimleri, hastanede kalış süreleri ve maliyetler iki grup arasında karşılaştırıldı. Acil servise ve/veya polikliniğe hematokezya ve/veya melena ve/veya hematemez nedeniyle başvuran hastalara gastroenterologlar tarafından tüm endoskopik prosedürler başvurudan sonraki 48 saat içinde gerçekleştirildi. Her hastada hemostaz yönteminin seçimi, kanamalı lezyonun konumuna, antiagregan ve antikoagülan kullanımına bağlı olarak, gastroenteroloğun kararına göre seçildi. Kalp hızı, kan basıncı ve hemoglobin düzeylerinin ilk stabilizasyonunu takiben 24 saat içinde, şok veya hemoglobin konsantrasyonlarında >2 g/dl azalma, taze hematemez veya melena yeniden kanamayı işaret eder olarak kabul edilmiştir. Bulgular: Hastaların demografik özellikleri açısından HC ve HF gruplarının karşılaştırma analizinde yaş ve cinsiyet homojendir. Her iki grupta işlem sonrası ilk 24 saatte hipotansiyon ve taşikardi gelişimi açısından yapılan karşılaştırma analizinde, anlamlı fark tespit edilmedi. HC ve HF tedavi gruplarında tekrarlayan kanama oranlarının arasında anlamlı fark bulunmadı. HC ve HF tedavi grupları arasında primer hemostaz oranları sırasıyla %83,33 ve %87,21 olarak saptandı (p=0,537). Her iki grupta hospitalizasyon süresi ortalama üç gün olarak tespit edildi (p=0,206). Maliyet açısından tedavi grupları karşılaştırıldığında, HC grubunda maliyet HF grubuna göre yüksek bulundu (p<0,001). Sonuç: Bu çalışma görece daha yeni olan HF tedavisinin HC kadar güvenli ve etkin olmasının yanı sıra maliyet etkinliği açısından HC'den üstün olduğunu göstermiştir. Bu bağlamda HF tedavisi uygun endikasyonda ÜGİK hastalarında kullanılabilir. Bu konuda daha geniş hasta sayısına sahip, prospektüs ve çok merkezli çalışmalara ihtiyaç vardır. Anahtar Kelimeler: Gastrointestinal kanama, sıcak forseps, hemoklips, endoskopi
Introduction: Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies encountered by physicians. The annual incidence is 133 per 100,000. Peptic ulcer disease is responsible for 31% to 67% of all cases and is the most common cause of UGIC. In addition, other causes can be listed as variceal bleeding, erosive diseases, Mallory-Weiss tear, Dieulafoy lesions, vascular ectasia and malignancy. Treatment is generally based on acid suppression and the use of endoscopic methods. Endoscopic techniques that can be used in the treatment of UGIB; injection therapy, thermal coagulation therapy, hemostatic clips, fibrin sealant, argon plasma coagulation, and epinephrine injection combined with a different technique. However, there is no clear evidence as to which method is best and should constitute the method of choice. The endoscopist's personal preference, available equipment, location and the characteristics of the lesion play a role in treatment selection. Hemoclip (HC) and thermal therapy, alone or in combination with injection therapy, have been shown to prevent recurrent bleeding and surgical intervention more effectively than injection therapy alone. Endoscopic HC is a mechanical technique frequently used in the treatment of UGIB. This mechanical apparatus provides hemostasis by attaching to the bleeding lesion and peripheral tissue. Thermal treatments provide hemostasis by providing thermal vascular constriction. There are three main types of thermal contact devices; multipolar probes, heating probes and monopolar probes. The low-cost hot forceps (HF) work similarly to the monopolar hemostatic forceps. HF is particularly useful in providing hemostasis in polypectomy and endoscopic submucosal dissection (ESD). In this study, we performed a retrospective comparison of the efficacy and cost-effectiveness of HC and HF in the treatment of UGIB. Material and Method: The study was carried out in Düzce University Training and Research Hospital, Department of Gastroenterology and Internal Medicine; between June 2017 and March 2022. The patients were selected from those who volunteered to participate in the study and a written informed consent form was obtained. During endoscopy, hot forceps or hemoclip applications are routinely applied to patients with upper gastrointestinal bleeding, if necessary. The patients v were divided into two groups according to the endoscopic hemostatic method applied. The HF group was selected from people who underwent hot forceps coagulation, and the HC group was selected from people who underwent hemoclips. Primary hemostasis rates, recurrent bleeding, transfusion requirements, hospital stay and costs were compared between the two groups. All endoscopic procedures. Results: Demographic characteristics of the patients were similar betten the groups. The rates of hypotension and tachycardia in the first 24 hours after the procedure, şaş statistically not significant between the groups. There was no significant difference between the rates of recurrent bleeding in the HC and HF treatment groups. Primary hemostasis rates between HC and HF treatment groups were 83.33% and 87.21%, respectively (p=0,537). In both groups, the average hospitalization time was three days (p=0,206). The cost was higher in the HC group compared to the HF group (p<0,001). Conclusion: This study showed that the relatively newer HF therapy is as safe and effective as HC, as well as being superior to HC in terms of cost effectiveness. In this context, we recommend HF treatment in patients with UGIC in appropriate indications. We believe that our study will shed light on new research on this subject. Keywords: Gastrointestinal bleeding, hot forceps, hemoclips, endoscop
Introduction: Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies encountered by physicians. The annual incidence is 133 per 100,000. Peptic ulcer disease is responsible for 31% to 67% of all cases and is the most common cause of UGIC. In addition, other causes can be listed as variceal bleeding, erosive diseases, Mallory-Weiss tear, Dieulafoy lesions, vascular ectasia and malignancy. Treatment is generally based on acid suppression and the use of endoscopic methods. Endoscopic techniques that can be used in the treatment of UGIB; injection therapy, thermal coagulation therapy, hemostatic clips, fibrin sealant, argon plasma coagulation, and epinephrine injection combined with a different technique. However, there is no clear evidence as to which method is best and should constitute the method of choice. The endoscopist's personal preference, available equipment, location and the characteristics of the lesion play a role in treatment selection. Hemoclip (HC) and thermal therapy, alone or in combination with injection therapy, have been shown to prevent recurrent bleeding and surgical intervention more effectively than injection therapy alone. Endoscopic HC is a mechanical technique frequently used in the treatment of UGIB. This mechanical apparatus provides hemostasis by attaching to the bleeding lesion and peripheral tissue. Thermal treatments provide hemostasis by providing thermal vascular constriction. There are three main types of thermal contact devices; multipolar probes, heating probes and monopolar probes. The low-cost hot forceps (HF) work similarly to the monopolar hemostatic forceps. HF is particularly useful in providing hemostasis in polypectomy and endoscopic submucosal dissection (ESD). In this study, we performed a retrospective comparison of the efficacy and cost-effectiveness of HC and HF in the treatment of UGIB. Material and Method: The study was carried out in Düzce University Training and Research Hospital, Department of Gastroenterology and Internal Medicine; between June 2017 and March 2022. The patients were selected from those who volunteered to participate in the study and a written informed consent form was obtained. During endoscopy, hot forceps or hemoclip applications are routinely applied to patients with upper gastrointestinal bleeding, if necessary. The patients v were divided into two groups according to the endoscopic hemostatic method applied. The HF group was selected from people who underwent hot forceps coagulation, and the HC group was selected from people who underwent hemoclips. Primary hemostasis rates, recurrent bleeding, transfusion requirements, hospital stay and costs were compared between the two groups. All endoscopic procedures. Results: Demographic characteristics of the patients were similar betten the groups. The rates of hypotension and tachycardia in the first 24 hours after the procedure, şaş statistically not significant between the groups. There was no significant difference between the rates of recurrent bleeding in the HC and HF treatment groups. Primary hemostasis rates between HC and HF treatment groups were 83.33% and 87.21%, respectively (p=0,537). In both groups, the average hospitalization time was three days (p=0,206). The cost was higher in the HC group compared to the HF group (p<0,001). Conclusion: This study showed that the relatively newer HF therapy is as safe and effective as HC, as well as being superior to HC in terms of cost effectiveness. In this context, we recommend HF treatment in patients with UGIC in appropriate indications. We believe that our study will shed light on new research on this subject. Keywords: Gastrointestinal bleeding, hot forceps, hemoclips, endoscop
Açıklama
Anahtar Kelimeler
İç Hastalıkları, Internal diseases
