==================================HSR34================================== 34. Electrocoagulation for gastrointestinal hemorrhage. 1 UI - 87079925 AU - Nivatvongs S TI - Complications in colonoscopic polypectomy. An experience with 1,555 polypectomies. AB - One thousand five-hundred fifty-five polyps were removed from 1172 patients; the sizes ranged from 5 mm to 6 cm. Nineteen complications accounted for 1.2 percent. Bleeding was the most common complication, followed by transmural burn. Other complications included a silent free perforation, a snare-wire entrapment, and an ensnared bowel wall. The complications in colonoscopic polypectomy are low. With proper technique, better selection of patients, and a broad knowledge of the causes and mechanisms, however, the complication rate can be reduced even more. MH - Adult ; Aged ; Burns/ETIOLOGY ; Colonic Polyps/PATHOLOGY/*SURGERY ; Colonoscopy ; Electrocoagulation/ADVERSE EFFECTS ; Female ; Hemorrhage, Gastrointestinal/ETIOLOGY ; Human ; Male ; Middle Age ; *Postoperative Complications ; Prospective Studies SO - Dis Colon Rectum 1986 Dec;29(12):825-30 2 UI - 87022697 AU - Thatcher BS TI - Therapeutic endoscopy for gastrointestinal bleeding. AB - Patients with variceal or other gastrointestinal hemorrhage require aggressive resuscitative measures and early diagnosis for optimal therapy. A number of nonsurgical endoscopic modalities, such as laser therapy, sclerotherapy, heater probe and electrocoagulation (monopolar or bipolar), are available to arrest and sometimes to prevent hemorrhage. The family physician should be aware of these options so that access to them can be offered to patients if needed. MH - Electrocoagulation/METHODS ; Endoscopy/*METHODS ; Esophageal and Gastric Varices/COMPLICATIONS/THERAPY ; Heat/THERAPEUTIC USE ; Hemorrhage, Gastrointestinal/ETIOLOGY/*THERAPY ; Human ; Lasers/THERAPEUTIC USE ; Sclerosing Solutions/THERAPEUTIC USE ; Vasopressins/ADVERSE EFFECTS/ THERAPEUTIC USE SO - Am Fam Physician 1986 Oct;34(4):139-43 3 UI - 86279440 AU - Sanowski RA TI - Thermal application for gastrointestinal bleeding. AB - Advances in therapeutic endoscopy have brought to the gastroenterologist a host of new devices capable of controlling hemorrhage. Variations of cautery including monopolar and bipolar units and the heater probe, provide a choice in current therapy. Use of the laser in gastrointestinal hemorrhage may be eclipsed by these small, portable, reasonably priced instruments. Microwave tissue coagulation represents an application to clinical medicine of an energy source found in many kitchens. I review the current status of these devices to help practitioners to determine which to purchase and choose for the treatment of gastrointestinal hemorrhage. MH - *Electrocoagulation/ECONOMICS/INSTRUMENTATION/METHODS ; Gastroscopy/ INSTRUMENTATION ; Heat/*THERAPEUTIC USE ; Hemorrhage, Gastrointestinal/ *THERAPY ; Human ; Lasers/THERAPEUTIC USE ; Microwaves/THERAPEUTIC USE SO - J Clin Gastroenterol 1986 Jun;8(3 Pt 1):239-44 4 UI - 86273841 AU - Goff JS TI - Bipolar electrocoagulation versus Nd-YAG laser photocoagulation for upper gastrointestinal bleeding lesions. AB - Nd-YAG laser photocoagulation and bipolar electrocoagulation may be useful for controlling upper gastrointestinal bleeding or preventing rebleeding from ulcers with visible vessels. To determine if one of these methods is superior to the other, data from a small randomized trial and from a nonrandomized experience were evaluated. Altogether, 33 patients underwent 37 coagulation sessions; 19 of the patients were randomized (8 laser and 11 bipolar). In the randomized group, 47.4% had no rebleeding after therapy (laser = 37.5% and bipolar = 54.5%, P greater than 0.1). In the nonrandomized group 56.8% had no further bleeding. Eleven (33%) of the patients required surgery. No patients died of bleeding or complications related to the study. From these data and those in the literature, it is concluded that the Nd-YAG laser and the bipolar coagulator are equally effective for the treatment of solitary upper gastrointestinal bleeding lesions. Since the bipolar unit is cheaper and more easily transported than the laser unit, it may be the method of choice for cauterizing upper gastrointestinal sources until a more effective method is developed. MH - Adult ; Aged ; Comparative Study ; *Electrocoagulation ; Evaluation Studies ; Female ; Hemorrhage, Gastrointestinal/*SURGERY ; Human ; Lasers ; *Light Coagulation ; Male ; Middle Age ; Random Allocation SO - Dig Dis Sci 1986 Sep;31(9):906-10 5 UI - 86273840 AU - Quintero E ; Piqu:e JM ; Bomb:i JA ; Ros E ; Bordas JM ; Rives A ; Ter:es J ; Rod:es J TI - Upper gastrointestinal bleeding caused by gastroduodenal vascular malformations. Incidence, diagnosis, and treatment. AB - Within a two-year period, 12 patients with upper gastrointestinal bleeding due to gastroduodenal vascular malformations were admitted to a specialized intensive care unit. They represented 2.1% of all admissions for upper gastrointestinal bleeding, and 3.7% of those with severe hemorrhage (greater than or equal to 2 units of blood transfused). Early endoscopy was nondiagnostic during the first bleeding episode in all nine patients with nonhereditary vascular malformations; the diagnosis was eventually made after relapsing hemorrhage by repeat endoscopy in five patients, angiography in two, and histology in another two. These nine patients accounted for 23.6% of all cases of upper gastrointestinal bleeding considered to be of unknown origin after initial work-up. The remaining three patients had Rendu-Osler-Weber disease, and the first endoscopy was diagnostic in all of them. Emergency treatment was required for 11 patients; surgery was undertaken in seven, and transendoscopic therapy (electrocoagulation or endoscopic clipping) in four. There was a 25% mortality rate. No further bleeding has occurred in eight patients after a mean follow-up period of two years. Gastroduodenal vascular malformations are a more frequent cause of upper gastrointestinal bleeding than heretofore recognized, especially in patients whose hemorrhage is deemed to be of unknown origin after an initial work-up. Endoscopy, which may need to be repeated, is the most rewarding diagnostic procedure. Awareness of their possible existence facilitates endoscopic recognition. When available, transendoscopic therapy is a good choice to stop active bleeding from such lesions. MH - Adolescence ; Adult ; Aged ; Blood Vessels/*ABNORMALITIES/PATHOLOGY ; Electrocoagulation ; Endoscopy ; Esophageal and Gastric Varices/ COMPLICATIONS ; Female ; Gastrectomy ; Hemorrhage, Gastrointestinal/ DIAGNOSIS/*ETIOLOGY/THERAPY ; Human ; Male ; Middle Age ; Peptic Ulcer/ COMPLICATIONS SO - Dig Dis Sci 1986 Sep;31(9):897-905 6 UI - 86272686 AU - Salmon PR ; Jong M TI - Endoscopic haemostasis of the upper gastrointestinal tract. AB - The realm of endoscopy has gone from that of diagnosis to that of diagnosis and therapy. Therapeutic endoscopy is a rapidly advancing frontier in the field of gastroenterology. Its use in securing haemostasis has recently flourished. Considerable progress has been made. Various experimental techniques have been tried and found lacking, while others, such as laser photocoagulation, electrohydrocoagulation and endoscopic sclerotherapy, are proving to be very useful. The mortality for upper gastrointestinal bleeding has remained high for decades, despite recent advances in medicine. This may be related to the shift in the population toward the older age group. Recent advances in endoscopic haemostasis seem to be showing promise in improving survival rates. This is a result of improved recognition of risk factors, including the stigmata of recent haemorrhage, of early surgical intervention in the elderly, and of the ability to reliably secure haemostasis endoscopically. This chapter gives an account of the various techniques of endoscopic haemostasis and explains the numerous controversies through the discussion of selected experimental and clinical trials. MH - Clinical Trials ; Electrocoagulation ; *Endoscopy/METHODS ; Heat ; Hemorrhage, Gastrointestinal/*THERAPY ; *Hemostatic Technics ; Human ; Lasers/THERAPEUTIC USE ; Light Coagulation ; Sclerosing Solutions ; Tissue Adhesives SO - Clin Gastroenterol 1986 Apr;15(2):321-31 7 UI - 86219935 AU - Matek W ; Demling L TI - Hemostasis--therapeutic alternatives to the laser. AB - In clinical practice, there are a number of other endoscopic procedures for attaining hemostasis available as alternatives to laser hemostasis. Of these the following may be emphasized: Modified electrocoagulation procedures such as EHT coagulation, bipolar or multipolar coagulation, and sclerotherapy. The efficacy of these "laser-alternative: methods of hemostasis has already been demonstrated in clinical studies, and is unquestioned. Large comparative investigations that would provide definitive information on the relative effectiveness of the various techniques, have yet to be carried out. If, however, we consider such aspects as practicability and economy, the laser would appear to be a "dinosaur: among the endoscopic procedures presently available for hemostasis. The oldest recognized fiber-endoscopic instrument for hemostasis, it is anything but highly mobile, and is bound to a fixed location. In addition, it is as expensive as a museum exhibit. If the only indication for its use were hemostasis, it would probably have vanished from the scene. MH - Electrocoagulation/METHODS ; Endoscopy ; Hemorrhage, Gastrointestinal/ *THERAPY ; *Hemostatic Technics ; Human ; Lasers/THERAPEUTIC USE ; Recurrence ; Sclerosing Solutions/THERAPEUTIC USE SO - Endoscopy 1986 Mar;18 Suppl 1:17-20 8 UI - 86197505 AU - Caos A ; Benner KG ; Manier J ; McCarthy DM ; Blessing LD ; Katon RM ; Gogel HK TI - Colonoscopy after Golytely preparation in acute rectal bleeding. AB - Thirty-five consecutive patients with acute hematochezia, negative gastric aspirates, and negative sigmoidoscopy underwent urgent colonoscopy after Golytely purgation. Mucosal visualization was excellent. Colonic bleeding lesions were identified in 24 of 35 patients, and hemorrhage originating proximal to the ileoceal valve was documented in three of these 35 patients. Therapeutic endoscopic electrocautery, employed in 12 of 35 patients, was effective in 11. The peroral preparation was well tolerated, and there were no complications of the preparation or of colonoscopy. The data suggest that urgent colonoscopy following Golytely purgation is a safe, sensitive, and specific diagnostic procedure that provides an opportunity for early nonoperative treatment of acute colonic hemorrhage. MH - Adolescence ; Adult ; Aged ; Child ; Colonic Diseases/*DIAGNOSIS/SURGERY ; Colonoscopy/*METHODS ; Electrocoagulation ; *Electrolytes ; Female ; Hemorrhage, Gastrointestinal/*DIAGNOSIS/SURGERY ; Human ; Irrigation ; Male ; Middle Age ; *Polyethylene Glycols ; Rectum ; Support, U.S. Gov't, Non-P.H.S. SO - J Clin Gastroenterol 1986 Feb;8(1):46-9 9 UI - 86152250 AU - Himal HS TI - Therapeutic endoscopy. AB - The development of flexible endoscopic instruments has altered the surgical approach to many disease processes. Endoscopic treatment of gastrointestinal polyps, common bile duct stones and foreign bodies of the gastrointestinal tract has now become the preferred method of treatment. Endoscopic gastrostomy is replacing surgical gastrostomy for the patient who requires long term enteral nutrition. Sclerosis of esophageal varices has now become the preferred method of managing patients with portal hypertension and bleeding esophageal varices. As newer endoscopic instruments are developed, more and more operative procedures will be carried out by endoscopic methods. MH - Biliary Tract Neoplasms/SURGERY ; Carcinoma/SURGERY ; Colonic Diseases/ SURGERY ; Colonoscopy/METHODS ; Electrocoagulation ; *Endoscopy/METHODS ; Esophageal Neoplasms/SURGERY ; Esophageal Stenosis/SURGERY ; Fiber Optics ; Foreign Bodies/SURGERY ; Gastrointestinal Diseases/*SURGERY ; Hemorrhage, Gastrointestinal/THERAPY ; Human ; Intestinal Polyps/SURGERY ; Intubation, Gastrointestinal ; Lasers/THERAPEUTIC USE ; Pancreatitis/ SURGERY ; Review ; Sclerosing Solutions/THERAPEUTIC USE ; Vater's Ampulla/ SURGERY SO - Surg Gynecol Obstet 1986 Mar;162(3):291-9 10 UI - 86145789 AU - O'Brien JD ; Day SJ ; Burnham WR TI - Controlled trial of small bipolar probe in bleeding peptic ulcers. AB - 204 of 460 patients with upper gastrointestinal bleeding admitted to a busy district hospital were found to be bleeding from peptic ulcers or to have signs of recent haemorrhage at endoscopy within 24 h of admission. To determine if the small bipolar probe could stop bleeding or rebleeding, patients were allocated to electrocoagulation (101) or not (103); other aspects of treatment were identical. Groups were stratified by ulcer site to give similar numbers in each. To allow for differences in sex, age, initial haemoglobin, presence of other diseases, and shock, data were analysed by logistic regression. Fewer patients in the treated group (17) continued to bleed or rebled compared with controls (34). Rebleeding and mortality rates in the treated group were higher early in the trial, suggesting the need for experience in application of the probe. Further improvements in technology and technique may result in significant reductions in mortality. MH - Clinical Trials ; Duodenal Ulcer/SURGERY ; Electrocoagulation/ *INSTRUMENTATION/METHODS ; Gastroscopy ; Human ; Peptic Ulcer Hemorrhage/ *SURGERY ; Random Allocation ; Recurrence ; Regression Analysis ; Stomach Ulcer/SURGERY SO - Lancet 1986 Mar 1;1(8479):464-7 11 UI - 86134810 AU - Wara P TI - Endoscopic management of the bleeding ulcer. A survey. AB - The study was performed to evaluate the prognostic and therapeutic value of endoscopy in patients with bleeding ulcer. Before endoscopic control of ulcer bleeding was introduced 373 patients with bleeding ulcer and a median age of 67 years were studied retrospectively. Emergency surgery was required in 155 patients. The surgical mortality was 11% in 37 low risk patients, but 36% in 118 poor risk patients. There was a trend to improved outcome after introduction of diagnostic endoscopy but only in patients with hemorrhage managed conservatively. Surgical mortality remained unchanged. Ranked in order of prognostic importance, a complicating disorder, postoperative complications, overtransfusion, and absent past history of ulcer dyspepsia were identified as the most important determinants of fatal outcome. Age, onset of hemorrhage at home or in hospital, previous ulcer surgery, previous bleeds, ulcer site, and sex had comparatively less bearing on outcome. It was concluded that although surgery was efficient in preventing exsanguination, it was poorly tolerated in poor surgical risks who constituted 76% of the patients in need of emergency control of ulcer bleeding. The results indicate that the search for non-surgical methods is justified. In a pilot study, endoscopic electrocoagulation was applied to control ulcer bleeding in 60 patients. The experience from the study served as basis for a prospective study in an attempt to assess the prognostic and therapeutic potential of endoscopy in the management of bleeding ulcer and to define indications for emergency endoscopy. The histomorphologic effect of electrocoagulation employed to stop bleeding from acute gastric ulcers in rabbits suggested that intravascular occlusive fibrin thrombosis is the probable mechanism of hemostasis. In the prospective study, 539 consecutive patients admitted with hematemesis and melena underwent emergency endoscopy. Peptic ulcer, identified as the bleeding source in 51% of these patients, was the predominant lesion most liable to hemorrhage assessed as requiring emergency surgery. Black hematemesis with melena, occurring in 13% of the patients, was the best predictor of ulcer bleeding. Red hematemesis with melena (26%) was the most important predictor of major bleeding. Black hematemesis with melena was found to be as important as red hematemesis without melena (22%) in predicting major ulcer bleeding. In contrast, melena (18%) and, in particular, black hematemesis without melena (20%) were poor predictors of ulcer bleeding as well as of major bleeding.(ABSTRACT TRUNCATED AT 400 WORDS) MH - *Electrocoagulation ; *Emergencies ; *Endoscopy ; Human ; Peptic Ulcer Hemorrhage/DIAGNOSIS/*SURGERY ; Pilot Projects ; Postoperative Complications/SURGERY ; Prognosis ; Recurrence ; Risk SO - Dan Med Bull 1986 Feb;33(1):1-11