The Korean journal of internal medicine

  • 제33권2호
  • /
  • Pages.304-312
  • /
  • 2018
  • /
  • 1226-3303(pISSN)
  • /
  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

Early versus late bedside endoscopy for gastrointestinal bleeding in critically ill patients

  • Kim, Jee Hyun (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Kim, Ji Hye (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Chun, Jaeyoung (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Lee, Changhyun (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Im, Jong Pil (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Kim, Joo Sung (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine)
  • 투고 : 2016.05.16
  • 심사 : 2016.10.21
  • 발행 : 2018.03.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Gastrointestinal (GI) bleeding is a life-threatening complication in critically ill patients. The aim of this study was to determine the efficacy of bedside endoscopy in an intensive care unit (ICU) setting, and to compare the outcomes of early endoscopy (within 24 hours of detecting GI bleeding) with late endoscopy (after 24 hours). Methods: We retrospectively reviewed the medical records of patients who underwent bedside endoscopy for nonvariceal upper GI bleeding and lower GI bleeding that occurred after ICU admission at Seoul National University Hospital from January 2010 to May 2015. Results: Two hundred and fifty-three patients underwent bedside esophagogastroduodenoscopy (EGD) for upper GI bleeding (early, 187; late, 66) and 69 underwent bedside colonoscopy (CS) for lower GI bleeding (early, 36; late, 33). Common endoscopic findings were peptic ulcer, and acute gastric mucosal lesion in the EGD group, as well as ischemic colitis and acute hemorrhagic rectal ulcers in the CS group. Early EGD significantly increased the rate of finding the bleeding focus (82% vs. 73%, p = 0.003) and endoscopic hemostasis (32% vs. 12%, p = 0.002) compared with late EGD. However, early CS significantly decreased the rate of identifying the bleeding focus (58% vs. 82%, p = 0.008) and hemostasis (19% vs. 49%, p = 0.011) compared with late CS due to its higher rate of poor bowel preparation and blood interference (38.9% vs. 6.1%, p = 0.035). Conclusions: Early EGD may be effective for diagnosis and hemostatic treatment in ICU patients with GI bleeding. However, early CS should be carefully performed after adequate bowel preparation.

키워드

참고문헌

  1. Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992;102:139-148. https://doi.org/10.1016/0016-5085(92)91793-4
  2. Peterson WL, Barnett CC, Smith HJ, Allen MH, Corbett DB. Routine early endoscopy in upper-gastrointestinaltract bleeding: a randomized, controlled trial. N Engl J Med 1981;304:925-929. https://doi.org/10.1056/NEJM198104163041601
  3. Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purge. Gastroenterology 1988;95:1569-1574. https://doi.org/10.1016/S0016-5085(88)80079-9
  4. Green BT, Rockey DC, Portwood G, et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol 2005;100:2395-2402. https://doi.org/10.1111/j.1572-0241.2005.00306.x
  5. Lewis JD, Shin EJ, Metz DC. Characterization of gastrointestinal bleeding in severely ill hospitalized patients. Crit Care Med 2000;28:46-50. https://doi.org/10.1097/00003246-200001000-00007
  6. Lee YC, Wang HP, Wu MS, Yang CS, Chang YT, Lin JT. Urgent bedside endoscopy for clinically significant upper gastrointestinal hemorrhage after admission to the intensive care unit. Intensive Care Med 2003;29:1723-1728. https://doi.org/10.1007/s00134-003-1921-x
  7. Chak A, Cooper GS, Lloyd LE, Kolz CS, Barnhart BA, Wong RC. Effectiveness of endoscopy in patients admitted to the intensive care unit with upper GI hemorrhage. Gastrointest Endosc 2001;53:6-13. https://doi.org/10.1067/mge.2001.108965
  8. Aronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc 2000;52:346-352. https://doi.org/10.1067/mge.2000.108480
  9. Rockal l TA, Logan RF, Devl in HB, Northf ield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom: Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995;311:222-226. https://doi.org/10.1136/bmj.311.6999.222
  10. Chaudhry V, Hyser MJ, Gracias VH, Gau FC. Colonoscopy: the initial test for acute lower gastrointestinal bleeding. Am Surg 1998;64:723-728.
  11. Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000;342:78-82. https://doi.org/10.1056/NEJM200001133420202
  12. Kim BC, Cheon JH, Kim TI, Kim WH. Risk factors and the role of bedside colonoscopy for lower gastrointestinal hemorrhage in critically ill patients. Hepatogastroenterology 2008;55:2108-2111.
  13. Jensen DM, Machicado GA. Colonoscopy for diagnosis and treatment of severe lower gastrointestinal bleeding: routine outcomes and cost analysis. Gastrointest Endosc Clin N Am 1997;7:477-498.
  14. Garcia Sanchez M, Gonzalez Galilea A, Lopez Vallejos P, et al. Role of early colonoscopy in severe acute lower gastrointestinal bleeding. Gastroenterol Hepatol 2001;24:327-332. https://doi.org/10.1016/S0210-5705(01)70187-2
  15. Richter JM, Christensen MR, Kaplan LM, Nishioka NS. Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage. Gastrointest Endosc 1995;41:93-98. https://doi.org/10.1016/S0016-5107(05)80588-7
  16. Lin CC, Lee YC, Lee H, et al. Bedside colonoscopy for critically ill patients with acute lower gastrointestinal bleeding. Intensive Care Med 2005;31:743-746. https://doi.org/10.1007/s00134-005-2604-6
  17. Sanowski RA, Waring JP. Endoscopic injection therapy for nonvariceal bleeding lesions of the upper gastrointestinal tract. J Clin Gastroenterol 1989;11:247-252. https://doi.org/10.1097/00004836-198906000-00002
  18. Choudari CP, Rajgopal C, Palmer KR. Comparison of endoscopic injection therapy versus the heater probe in major peptic ulcer haemorrhage. Gut 1992;33:1159-1161. https://doi.org/10.1136/gut.33.9.1159
  19. Cipolletta L, Bianco MA, Marmo R, et al. Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointest Endosc 2001;53:147-151. https://doi.org/10.1067/mge.2001.111386
  20. Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992;102:139-148. https://doi.org/10.1016/0016-5085(92)91793-4
  21. Schuster DP, Rowley H, Feinstein S, McGue MK, Zuckerman GR. Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit. Am J Med 1984;76:623-630. https://doi.org/10.1016/0002-9343(84)90286-9
  22. Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients: Canadian Critical Care Trials Group. N Engl J Med 1994;330:377-381. https://doi.org/10.1056/NEJM199402103300601

피인용 문헌

  1. Mallory-Weiss syndrome diagnosed after tracheal extubation vol.32, pp.2, 2018, https://doi.org/10.1007/s00540-017-2445-9
  2. Bedside endoscopy of patients with gastrointestinal bleeding: early does not mean hurried vol.33, pp.2, 2018, https://doi.org/10.3904/kjim.2018.045
  3. Role of endoscopy in acute gastrointestinal bleeding in real clinical practice: An evidence-based review vol.11, pp.2, 2019, https://doi.org/10.4253/wjge.v11.i2.68
  4. Clinical outcomes of esophagogastroduodenoscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding : A retrospective cohort study vol.100, pp.34, 2018, https://doi.org/10.1097/md.0000000000027028
  5. Does timing of endoscopy affect outcomes in patients with upper gastrointestinal bleeding: a systematic review and meta-analysis vol.33, pp.8, 2018, https://doi.org/10.1097/meg.0000000000001975
  6. A clinical approach to acute mesenteric ischemia vol.27, pp.2, 2018, https://doi.org/10.1097/mcc.0000000000000802