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  • Title: [Possibilities and limits of endoscopic therapy in hemorrhage of the gastrointestinal tract].
    Author: Fleig WE.
    Journal: Leber Magen Darm; 1987 Apr; 17(2):69-79. PubMed ID: 3495714.
    Abstract:
    Most of the hemostatic modalities currently used for endoscopic therapy of gastrointestinal bleeding are based on the principle of thermic coagulation of protein. Injection of vasoactive and sclerosing agents is also widely used, while the application of various other methods is rather limited. There are specific benefits and drawbacks inherent with each of the treatment modalities. The efficacy of laser photocoagulation in stopping upper gastrointestinal bleeding has been demonstrated in several controlled trials; however, effects on survival are controversial. None of the other methods used has been evaluated sufficiently by controlled clinical trials up to date. Depending on the availability at a local institution, each of the various methods may be used for an attempt of endoscopic hemostasis when Forrest type I and II (visible vessel) lesions are detected at emergency endoscopy. However, patients suffering from lesions, which are notable for their high risk of recurrent bleeding like ulcers with a spurting artery, with a visible vessel and lesions at the posterior wall of the duodenum, should be transferred to the surgeon for operative treatment in the absence of active bleeding immediately after successful endoscopic treatment. In the future, patients requiring surgery despite effective endoscopic hemostasis might be identified with high accuracy by checking the coagulated or injected ulcer base with an endoscopic Doppler device.
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