Universität zu Köln

Werner, David John, Baar, Till ORCID: 0000-0002-6744-1463, Kiesslich, Ralf, Wenzel, Nicolai, Abusalim, Nael, Tresch, Achim ORCID: 0000-0002-4146-6371 and Rey, Johannes Wilhelm (2021). Endoscopic hemostasis makes the difference: Angiographic treatment in patients with lower gastrointestinal bleeding. World J. Gastrointest. Endosc., 13 (7). S. 221 - 233. PLEASANTON: BAISHIDENG PUBLISHING GROUP INC. ISSN 1948-5190

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Abstract

BACKGROUND The large majority of gastrointestinal bleedings subside on their own or after endoscopic treatment. However, a small number of these may pose a challenge in terms of therapy because the patients develop hemodynamic instability, and endoscopy does not achieve adequate hemostasis. Interventional radiology supplemented with catheter angiography (CA) and transarterial embolization have gained importance in recent times. AIM To evaluate clinical predictors for angiography in patients with lower gastro-intestinal bleeding (LGIB). METHODS We compared two groups of patients in a retrospective analysis. One group had been treated for more than 10 years with CA for LGIB (n = 41). The control group had undergone non-endoscopic or endoscopic treatment for two years and been registered in a bleeding registry (n = 92). The differences between the two groups were analyzed using decision trees with the goal of defining clear rules for optimal treatment. RESULTS Patients in the CA group had a higher shock index, a higher Glasgow-Blatchford bleeding score (GBS), lower serum hemoglobin levels, and more rarely achieved hemostasis in primary endoscopy. These patients needed more transfusions, had longer hospital stays, and had to undergo subsequent surgery more frequently (P < 0.001). CONCLUSION Endoscopic hemostasis proved to be the crucial difference between the two patient groups. Primary endoscopic hemostasis, along with GBS and the number of transfusions, would permit a stratification of risks. After prospective confirmation of the present findings, the use of decision trees would permit the identification of patients at risk for subsequent diagnosis and treatment based on interventional radiology.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Werner, David John UNSPECIFIED UNSPECIFIED UNSPECIFIED Baar, Till UNSPECIFIED orcid.org/0000-0002-6744-1463 UNSPECIFIED Kiesslich, Ralf UNSPECIFIED UNSPECIFIED UNSPECIFIED Wenzel, Nicolai UNSPECIFIED UNSPECIFIED UNSPECIFIED Abusalim, Nael UNSPECIFIED UNSPECIFIED UNSPECIFIED Tresch, Achim UNSPECIFIED orcid.org/0000-0002-4146-6371 UNSPECIFIED Rey, Johannes Wilhelm UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-579766
DOI:	10.4253/wjge.v13.i7.221
Journal or Publication Title:	World J. Gastrointest. Endosc.
Volume:	13
Number:	7
Page Range:	S. 221 - 233
Date:	2021
Publisher:	BAISHIDENG PUBLISHING GROUP INC
Place of Publication:	PLEASANTON
ISSN:	1948-5190
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Sonstiges > Zentrum für Versorgungsforschung Köln
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language SELECTIVE MESENTERIC EMBOLIZATION; URGENT COLONOSCOPY; MANAGEMENT; DIAGNOSIS; HEMORRHAGE; GUIDELINE Multiple languages Gastroenterology & Hepatology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/57976