Читать книгу Successful Training in Gastrointestinal Endoscopy - Группа авторов - Страница 97

For GI bleeding due to ulcer disease, it is important to note the appearance of the ulceration to guide whether endoscopic therapy and further hospitalization are needed. If an ulcer with a clean base is seen, the subsequent rate of rebleeding has been estimated to be less than 5%, while ulcerations with active bleeding and/or visible vessels have rebleeding rates over 50% [14]. The trainee should record the associated Forrest classification in the endoscopy report [15]. Injection of epinephrine in a 1:10,000 dilution using an injection needle around the base of the ulceration is not effective as solo therapy to decrease rebleeding rates, but can be used for initial hemostasis to improve visualization in the setting of active bleeding and in combination with either thermal coagulation therapy or hemoclips [16]. When using thermal therapy, the trainee should be taught how to apply either direct probe pressure on the vessel until coagulation is achieved or noncontact coagulation with argon plasma. If using hemoclips, these should be applied directly on or around the vessel and can be repeatedly applied until bleeding has stopped. The utilization of hemoclips may be more challenging in angulated areas such as the first portion of the duodenum.