Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience
Background and study aims Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown. Patien...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2018-12-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-0749-0011 |
| _version_ | 1818558168625577984 |
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| author | Amol Agarwal Petros Benias Olaya I. Brewer Gutierrez Vivien Wong Yuri Hanada Juliana Yang Vipin Villgran Vivek Kumbhari Anthony Kalloo Mouen A. Khashab Philip Chiu Saowanee Ngamruengphong |
| author_facet | Amol Agarwal Petros Benias Olaya I. Brewer Gutierrez Vivien Wong Yuri Hanada Juliana Yang Vipin Villgran Vivek Kumbhari Anthony Kalloo Mouen A. Khashab Philip Chiu Saowanee Ngamruengphong |
| author_sort | Amol Agarwal |
| collection | DOAJ |
| description | Background and study aims Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown.
Patients and methods This is an international case series of patients who underwent endoscopic suturing for bleeding PUD. Primary outcome was rate of immediate hemostasis and rate of early rebleeding (within 72 hours). Secondary outcomes included technical success, delayed rebleeding (> 72 hours), and rate of adverse events (AEs).
Results Ten patients (mean age 66.7 years, 30 % female) were included in this study. Nine (90 %) had prior failed endoscopy hemostasis with an average of 1.4 ± 0.7 (range 1 – 3) prior endoscopic sessions. Forrest classification was Ib in 5 (50 %), IIa in 3 (30 %), IIb in 1(10 %), and IIc in 1 (10 %). Mean suturing time was 13.4 ± 5.6 (range 3.5 to 20) minutes. Technical success was 100 %. Rate of immediate hemostasis was 100 % and rate of early rebleeding was 0 %. Mean number of sutures was 1.5 (range, 1 – 4). No AEs were observed. Delayed recurrent bleeding was not observed in any cases after a median of 11 months (range 2 – 56), after endoscopic suturing.
Conclusions Oversewing of a bleeding or high-risk ulcer using endoscopic suturing appears to be a safe and effective method for achieving endoscopic hemostasis. It may be considered as rescue endoscopic therapy when primary endoscopic hemostasis fails to control the bleeding or when hemorrhage recurs after successful control of bleeding. |
| first_indexed | 2024-12-14T00:09:13Z |
| format | Article |
| id | doaj.art-2110c835794244018b58ca06eab113f7 |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-14T00:09:13Z |
| publishDate | 2018-12-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-2110c835794244018b58ca06eab113f72022-12-21T23:25:50ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362018-12-010612E1439E144410.1055/a-0749-0011Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experienceAmol Agarwal0Petros Benias1Olaya I. Brewer Gutierrez2Vivien Wong3Yuri Hanada4Juliana Yang5Vipin Villgran6Vivek Kumbhari7Anthony Kalloo8Mouen A. Khashab9Philip Chiu10Saowanee Ngamruengphong11Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MDDivision of Gastroenterology, North Shore-Long Island Jewish Medical Center, Queens, NYDivision of Gastroenterology, Johns Hopkins Hospital, Baltimore, MDDepartment of Surgery, Chinese University of Hong Kong, Hong KongDivision of Gastroenterology, Johns Hopkins Hospital, Baltimore, MDDivision of Gastroenterology, Johns Hopkins Hospital, Baltimore, MDDivision of Gastroenterology, Johns Hopkins Hospital, Baltimore, MDDivision of Gastroenterology, Johns Hopkins Hospital, Baltimore, MDDivision of Gastroenterology, Johns Hopkins Hospital, Baltimore, MDDivision of Gastroenterology, Johns Hopkins Hospital, Baltimore, MDDepartment of Surgery, Chinese University of Hong Kong, Hong KongDivision of Gastroenterology, Johns Hopkins Hospital, Baltimore, MDBackground and study aims Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown. Patients and methods This is an international case series of patients who underwent endoscopic suturing for bleeding PUD. Primary outcome was rate of immediate hemostasis and rate of early rebleeding (within 72 hours). Secondary outcomes included technical success, delayed rebleeding (> 72 hours), and rate of adverse events (AEs). Results Ten patients (mean age 66.7 years, 30 % female) were included in this study. Nine (90 %) had prior failed endoscopy hemostasis with an average of 1.4 ± 0.7 (range 1 – 3) prior endoscopic sessions. Forrest classification was Ib in 5 (50 %), IIa in 3 (30 %), IIb in 1(10 %), and IIc in 1 (10 %). Mean suturing time was 13.4 ± 5.6 (range 3.5 to 20) minutes. Technical success was 100 %. Rate of immediate hemostasis was 100 % and rate of early rebleeding was 0 %. Mean number of sutures was 1.5 (range, 1 – 4). No AEs were observed. Delayed recurrent bleeding was not observed in any cases after a median of 11 months (range 2 – 56), after endoscopic suturing. Conclusions Oversewing of a bleeding or high-risk ulcer using endoscopic suturing appears to be a safe and effective method for achieving endoscopic hemostasis. It may be considered as rescue endoscopic therapy when primary endoscopic hemostasis fails to control the bleeding or when hemorrhage recurs after successful control of bleeding.http://www.thieme-connect.de/DOI/DOI?10.1055/a-0749-0011 |
| spellingShingle | Amol Agarwal Petros Benias Olaya I. Brewer Gutierrez Vivien Wong Yuri Hanada Juliana Yang Vipin Villgran Vivek Kumbhari Anthony Kalloo Mouen A. Khashab Philip Chiu Saowanee Ngamruengphong Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience Endoscopy International Open |
| title | Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience |
| title_full | Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience |
| title_fullStr | Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience |
| title_full_unstemmed | Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience |
| title_short | Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience |
| title_sort | endoscopic suturing for management of peptic ulcer related upper gastrointestinal bleeding a preliminary experience |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-0749-0011 |
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