Endoscopic Interventions for GI Bleeds

Endoscopic Interventions for GI Bleeds - GI Hemorrhage...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: GI Hemorrhage Trauma and SICU Conference 12/18/2006 Upper GI Bleeding Upper GI Bleeding Esophageal Varices Mallory­Weiss Tear Duodenal Ulcer Gastric Ulcer Gastritis Cancer Hemobilia Cranberry Sauce Lower Gastrointestinal Bleeding Lower Gastrointestinal Bleeding UGI Source Hemorrhoids, Fissure, Ulcer, Polyp Prolapse Volvulus/Malrotation Cancer Ulcerative Colitis Granulomatous Colitis Diverticulitis Other: Meckel’s Diverticulum Colonic Polyp Peutz­Jeghers Syndrome Osler­Weber­Rendu Syndrome Ileal Diverticula Duplication of Bowel Endoscopic Interventions for Gastrointestinal Bleeding Stephanie Chao, Trauma R1 Trauma Conference December 18, 2006 Endoscopic techniques Endoscopic techniques Anoscopy Sigmoidoscopy <45 years old with small volume bleed, may be sufficient for investigation unless bleeding/recurrence found Identifies anorectal disease, infectious colitis, inflammatory bowel disease EGD Colonoscopy Injection Rx Injection Rx Epinephrine 1­1.5ml of 1:10,000 or 1:20,000 in 4 quadrants Mechanism: vasoconstriction, volume tamponade Sclerosant (ethanolamine) Mechanism: Induces inflammation then fibrosis Fibrin Sealant Fibrinogen/Factor XIII and Thrombin/Calcium Mechanism: Instantaneous formation of hemostatic clot by mimicking last step of coagulation cascade Sclerosant trials vs. Fibrin sealant No advantage of epi + sclerosant over epi alone Saline Mechanism: volume tamponade Ethanol Thermal Coagulation Thermal Coagulation Heater probe Mechanism: tissue coagulation via heated ceramic tip Not limited by tissue water resistance, deeper heat penetration Higher risk of perforation Multipolar probe Mechanism: coagulates tissue by heating tissue temperature to >60 degrees Celsius via alternating positive and negative electrodes at tip Tissue desiccation prevents conduction to lower layers Argon Plasma Coagulant Mechanism: uses argon gas to deliver a plasma of evenly distributed thermal energy No contact, wider spray, less depth Coagulation Coagulation Active bleed Post Coagulation Thermal Coagulation Thermal Coagulation Heater probe Mechanism: tissue coagulation via heated ceramic tip Not limited by tissue water resistance, deeper heat penetration Higher risk of perforation Multipolar probe Mechanism: coagulates tissue by heating tissue temperature to >60 degrees Celsius via passing electricity between alternating positive and negative electrodes at tip Tissue desiccation prevents conduction to lower layers Argon Plasma Coagulant Mechanism: uses argon gas to deliver a plasma of evenly distributed thermal energy No contact, wider spray, less depth Multipolar Probe Multipolar Probe Thermal Coagulation Thermal Coagulation Heater probe Mechanism: tissue coagulation via heated ceramic tip Not limited by tissue water resistance, deeper heat penetration Higher risk of perforation Multipolar probe Mechanism: coagulates tissue by heating tissue temperature to >60 degrees Celsius via alternating positive and negative electrodes at tip Tissue desiccation prevents conduction to lower layers Argon Plasma Coagulant Mechanism: uses argon gas to deliver a plasma of evenly distributed thermal energy No contact, wider spray, less depth Argon Plasma Coagulant Argon Plasma Coagulant Hemostatic Clips Hemostatic Clips Occludes vessel Radiographic marker Risk Stratification – Peptic Ulcer Disease Risk Stratification – Peptic Ulcer Disease Low risk Flat spot, clean ulcer Rx: No endoscopic intervention, PPI only Intermediate Risk Ooze without clot or visible vessel Rx: Monotherapy with oral PPI High Risk Active bleed, non­bleeding visible vessel with clot Rx: Combination therapy (injection and coagulation, IV PPI) Visible vessel Rx: clip or coagulation and PPI Risk Stratification Risk Stratification Low risk Flat spot, clean ulcer Rx: No endoscopic intervention, PPI only Intermediate Risk Ooze without clot or visible vessel Rx: Monotherapy with oral PPI High Risk Active bleed, non­bleeding visible vessel with clot Rx: Combination therapy (injection and coagulation, IV PPI) Visible vessel Rx: clip or coagulation and PPI Risk Stratification Risk Stratification Low risk Flat spot, clean ulcer Rx: No endoscopic intervention, PPI only Intermediate Risk Ooze without clot or visible vessel Rx: Monotherapy with oral PPI High Risk Active bleed, non­bleeding visible vessel with clot Rx: Combination therapy (injection and coagulation, IV PPI) Visible vessel Rx: clip or coagulation and PPI Risk Stratification Risk Stratification Low risk Flat spot, clean ulcer Rx: No endoscopic intervention, PPI only Intermediate Risk Ooze without clot or visible vessel Rx: Monotherapy with oral PPI High Risk Active bleed, non­bleeding visible vessel with clot Rx: Combination therapy (injection and coagulation, IV PPI) Visible vessel Rx: clip or coagulation and PPI Varices Varices Banding References References Kubba, AK, Palmer, KR. Role of endoscopic injection therapy in the treatment of bleeding peptic ulcer. Br J Surg 1996; 83:461. Laine, L, Peterson, WL. Bleeding peptic ulcer. N Engl J Med 1994; 331:717. Jensen DM, Machicado GA. Endoscopic Hemostasis of Ulcer Hemorrhage with Injection, Thermal, or Combination Methods. Techniques in Gastrointestinal Endoscopy 2005; 7:124. Up­To­Date CMDT ...
View Full Document

This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

Ask a homework question - tutors are online