Diagnostic and treatment tactics in small bowel bleeding
Journal Title: Хірургія України - Year 2018, Vol 0, Issue 3
Abstract
The aim — to study the role of capsule endoscopy in defining the small intestinal bleeding tactics. Materials and methods. The clinical material used in the work is based on the diagnostic and treatment results of 194 patients with small intestinal bleeding, who were in the surgical and proctologic departments. The main group included 98 patients who were diagnosed and treated according to original algorithm for the period from May, 2013 to December, 2015. The comparison group included 96 patients, followed the traditional scheme from April, 2000 to December, 2015. Results and discussion. The results showed that using capsule endoscopy allows to detect a source of small intestinal bleeding in 92.8 % of patients. The predominant bleeding was erosive in genesis and stopped conservatively (infusion therapy including blood volume correction, 5aminosalicylic acid drugs, fibrinolysis inhibitors and vasopressin/somatostatin analogues). The conservative measures were also effective for ulcer bleeding. Urgent endoscopic intervention was the optimal tactic for vascular disorders. Patients needed the routine surgical treatment (endoscopic and open resections) after preexamination and preoperative preparation (infusiontransfusion therapy, correction of concomitant pathology) for neoplasms. In the main group, diagnostic laparotomies were not used, whereas in the comparison group they were performed in 45.8 % of cases. This testifies to the high effectiveness of capsular endoscopy in the diagnosis of the small intestinal bleeding source and the definition of therapeutic tactics. Conclusions. Original diagnostic algorithm application with capsule endoscopy and doubleballoon enteroscopy allows to reveal the small intestinal bleeding source in 92.8 % of patients in the main group and define the management. Therapeutic tactics for ongoing small intestinal bleeding from identified source with capsule endoscopy is urgent endoscopic or open surgery, and preexamination and planned surgical treatment for stopped small intestinal bleeding.
Authors and Affiliations
U. I. Grechana
Keywords
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- EP ID EP415751
- DOI 10.30978/SU2018-3-34
- Views 129
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