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© Borgis - New Medicine 1/2003, s. 41-43
Olivia Alexandra Sgarbura1, Dragos Cinteza1, Cristian Viorel Poalelungi1, Dan Cristian2
The impact of endoscopy on upper gastrointestinal haemorrhage
1 University of Medicine and Pharmacy „Carol Davila”
2 Coltea University Hospital, Bucharest
Summary
Aim: Upper GI haemorrhage (UGIH) is one of the most frequent reasons for referral to gastro-enterology and surgical clinics. This provides a strong motivation for updating diagnostic procedures, and range of therapeutic methods. Oesogastroduodenoscopy is a highly reliable visualising method, classically used for diagnosis but with growing importance in therapy. Our goal is to demonstrate that there is great benefit in accepting endoscopy as a common therapeutic procedure.
Methods: We studied cases of UGIH in an important Romanian clinical hospital throughout 2 years (2001 and 2002), identifying a group of 125 patients (man:woman ratio 1.45) aged between 30 and 87 years (average 58 years, SD = 13.9) that underwent diagnostic endoscopy. We analysed their medical files and evaluated the therapeutic procedures that were applied for the whole group and for aetiologic groups.
Results: In order to evaluate the therapeutic method, we first studied the aetiology and epidemiology of UGIH within the group. We found that the average age of men referred for UGIH was significantly lower than that of women (56.6 y compared to 59.2; p-value < 0.0002) and that gastric ulcer and oesophagitis are significantly more frequent in men (p < 0.0001 and p<0.05), the other causes of UGIH being almost equally distributed. Endoscopic treatment of UGIH occured in 43.2% of cases, only 9.6% of them needing surgery, which was very significant (p = 0). Compared to the approach that Forrest I and Forrest II UGIH have had previously, we noticed the growing role of endoscopy (p < 0.05) and the diminishing role of classic surgery (p < 0.0002) in the studied pathology.
Conclusion: The recent advance that endoscopy has shown as a treatment method is due to its reduced invasivity with less intraoperatory time, less anaesthetic risks, and higher diagnostic and therapeutic efficiency. The recent tendency is to replace classical surgery with endoscopic methods as much as possible, an important step in the treatment of UGIH and obtaining agood outcome.
Upper gastrointestinal haemorrhage is an important issue for doctors at the beginning of the 21st century, especially because of our changing habits in nutrition. Doctors working in departments such as digestive/general surgery, or gastroenterology, are often confronted with patients in the emergency room because of bleeding of the digestive tract. Therefore, we considered it useful to conduct a study that aimed to prove the therapeutic impact of endoscopy, its importance under all circumstances – both emergency and ambulatory referrals – and its flexibility for all ages.
Out of a large number of cases, we chose to address only patients with bleeding of the upper gastrointestinal tract (down to the Treitz angle), so that we could select only oesogastroduodenoscopy, and ignore colonoscopy. Our decision was based on several reasons: we could focus on a lesser amount of pathologies, we could conduct a study that would carefully consider several aspects of the clinical evolution, and oesogastroduodenoscopy offered us a wide enough range of therapeutic methods as can be seen in chart 1.

Chart 1. Classification of endoscopic therapeutical proce-dures.
Endoscopic haemostasisEndoscopic surgical proceduresOther endoscopic methods
Alcohol coagulationBandingInjection with local substances
ElectrocoagulationLigation
ThermocoagulationSclerotherapyApplication of topical substances
Laser photocoagulationClipping
In order to assess the impact of endoscopy on UGIH, we worked for two years (2001, 2002) in Coltea University Hospital, an important hospital located in the centre of Bucharest. From the patients that came for diagnosis and therapy, we selected those presenting UGIH, which resulted in a group of 125 patients with a man:woman ratio similar to that found in the literature – 1.45. Their ages were from 30 to 87 years, with an average age of 58 years (SD = 13.9) also similar to the average age described in medical publications. The similarity of data indicates that our group was representative of patients visiting Romanian hospitals with these signs. At the end of their stay in the hospital we reviewed all the patients" medical records and collected the important elements: sex, age, aetiology of UGIH, Forrest degree of UGIH, emergency referral Y/N, therapy, and comorbidity.
In order to structure our knowledge and our data, we chose a more elaborate study design that included four steps: the first step was to analyse the variation in UGIH depending on sex, and the second step was expected to perform a comparison between our population. and the data obtained for the general population. The third step was designed to reveal the impact of endoscopic therapeutic methods on the entire group of patients, and in the last step of our study we were to describe the impact of endoscopy on each aetiologic group. We identified significant factors by using statistical tests such as the Students" T-test, ZTest, Fisher test, chi-squared test, and relative risk calculations.

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Piśmiennictwo
1. Corley D.: Accute bleeds: Gaining control in emergency setting. Gastroenterology 2001; 120:946- 954. 2. Oelschlager B.K. et al.: Advancement in the use of Endoscopy for GERD. Medscape Gastroenterology eJournal, 2002. 3. Ziegler D. et al.: Comparison of endoscopic sclerotherapy versus endoscopic ligation of esophageal varices. SAGES, 2002. 4. Shahrier M. et al.: Endoluminal gastroplication (ELGP) improves acid-related pulmonary symptoms in GERD patients. Gastroenterology, 2002; 122:27. 5. Yol S. et al.: Endoscopic clipping versus band ligation in the management of bleeding esophageal varices. Kanya, Turkey, 2002. 6. Ponchon T. et al.: Endoscopic mucosal resection. J. Clini. Gastroenterol. 2001; 32:6-10. 7. Fennerty M.B.: Endoscopic therapies for GERD. Medscape Gastroenterol. eJ. 2002. 8. Waxman E.: Endoscopic treatment of early gastroesophageal malignacy. Current Opinion in Gastroenterology 2002; 18(5):587-594. 9. Merck Manual, 17th edition***,1999. 10. Vettoretto N. et al.: Surgical treatment of bleeding gastroduodenal ulcer: a retrospective analysis of 47 cases (1984-1999). Brescia, Italy, 1999. 11.Mantynen T. et al.: The impact of upper gi endoscopy referral volume on the diagnosis of gastroesophageal reflux disease and its complications: a 1-year cross-sectional study in a referral area with 260,000 inhabitants. Am. J. Gastroenterol. 2002; 97:2524-2529. 12. Krivchenya D.U. et al.: Treatment and prevention of bleeding in portal hypertension in children. Kiew, 1999.
New Medicine 1/2003
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