Skip to main content
Erschienen in: Der Internist 9/2010

01.09.2010 | CME Weiterbildung · Zertifizierte Fortbildung

Einteilung und Management der oberen gastrointestinalen Blutung

verfasst von: PD Dr. K. Herrlinger

Erschienen in: Die Innere Medizin | Ausgabe 9/2010

Einloggen, um Zugang zu erhalten

Zusammenfassung

Immer noch ist die obere gastrointestinale Blutung die häufigste Notfallsituation in der Gastroenterologie. Wegen der grundsätzlich verschiedenen Therapieansätze wird die Varizenblutung von der nicht-varikösen Blutung unterschieden. Essenziell sowohl für den Zeitpunkt der Endoskopie als auch zur Prognoseabschätzung ist die Risikoabschätzung bezüglich der Wahrscheinlichkeit einer Rezidivblutung, entsprechende Kriterien werden in dieser Arbeit diskutiert. Die modernen Therapieverfahren für beide Blutungssituationen werden mit ihren jeweiligen Erfolgsraten, aber auch Komplikationsrisiken dargestellt.
Literatur
1.
2.
Zurück zum Zitat Abid S, Jafri W, Hamid S et al (2009) Terlipressin vs. octreotide in bleeding esophageal varices as an adjuvant therapy with endoscopic band ligation: a randomized double-blind placebo-controlled trial. Am J Gastroenterol 104:617–623PubMedCrossRef Abid S, Jafri W, Hamid S et al (2009) Terlipressin vs. octreotide in bleeding esophageal varices as an adjuvant therapy with endoscopic band ligation: a randomized double-blind placebo-controlled trial. Am J Gastroenterol 104:617–623PubMedCrossRef
3.
Zurück zum Zitat Banares R, Albillos A, Rincon D et al (2002) Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 35:609–615PubMedCrossRef Banares R, Albillos A, Rincon D et al (2002) Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 35:609–615PubMedCrossRef
4.
Zurück zum Zitat Bernard B, Grange JD, Khac EN et al (1999) Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 29:1655–1661PubMedCrossRef Bernard B, Grange JD, Khac EN et al (1999) Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 29:1655–1661PubMedCrossRef
5.
Zurück zum Zitat Bianco MA, Rotondano G, Marmo R et al (2004) Combined epinephrine and bipolar probe coagulation vs. bipolar probe coagulation alone for bleeding peptic ulcer: a randomized, controlled trial. Gastrointest Endosc 60:910–915PubMedCrossRef Bianco MA, Rotondano G, Marmo R et al (2004) Combined epinephrine and bipolar probe coagulation vs. bipolar probe coagulation alone for bleeding peptic ulcer: a randomized, controlled trial. Gastrointest Endosc 60:910–915PubMedCrossRef
6.
Zurück zum Zitat Brullet E, Calvet X, Campo R et al (1996) Factors predicting failure of endoscopic injection therapy in bleeding duodenal ulcer. Gastrointest Endosc 43:111–116PubMedCrossRef Brullet E, Calvet X, Campo R et al (1996) Factors predicting failure of endoscopic injection therapy in bleeding duodenal ulcer. Gastrointest Endosc 43:111–116PubMedCrossRef
7.
Zurück zum Zitat Brullet E, Campo R, Calvet X et al (1996) Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer. Gut 39:155–158PubMedCrossRef Brullet E, Campo R, Calvet X et al (1996) Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer. Gut 39:155–158PubMedCrossRef
8.
Zurück zum Zitat Carbonell N, Pauwels A, Serfaty L et al (2006) Erythromycin infusion prior to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial. Am J Gastroenterol 101:1211–1215PubMedCrossRef Carbonell N, Pauwels A, Serfaty L et al (2006) Erythromycin infusion prior to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial. Am J Gastroenterol 101:1211–1215PubMedCrossRef
9.
Zurück zum Zitat Celinski K, Cichoz-Lach H, Madro A et al (2008) Non-variceal upper gastrointestinal bleeding–guidelines on management. J Physiol Pharmacol 59 (Suppl 2):215–229PubMed Celinski K, Cichoz-Lach H, Madro A et al (2008) Non-variceal upper gastrointestinal bleeding–guidelines on management. J Physiol Pharmacol 59 (Suppl 2):215–229PubMed
10.
Zurück zum Zitat Cheng LF, Wang ZQ, Li CZ et al (2007) Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 years‘ experience of 635 cases. Chin Med J (Engl) 120:2081–2085 Cheng LF, Wang ZQ, Li CZ et al (2007) Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 years‘ experience of 635 cases. Chin Med J (Engl) 120:2081–2085
11.
Zurück zum Zitat Chou YC, Hsu PI, Lai KH et al (2003) A prospective, randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers. Gastrointest Endosc 57:324–328PubMedCrossRef Chou YC, Hsu PI, Lai KH et al (2003) A prospective, randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers. Gastrointest Endosc 57:324–328PubMedCrossRef
12.
Zurück zum Zitat Cipolletta L, Bianco MA, Rotondano G et al (2002) Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 55:1–5PubMedCrossRef Cipolletta L, Bianco MA, Rotondano G et al (2002) Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 55:1–5PubMedCrossRef
13.
Zurück zum Zitat Coffin B, Pocard M, Panis Y et al (2002) Erythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study. Gastrointest Endosc 56:174–179PubMedCrossRef Coffin B, Pocard M, Panis Y et al (2002) Erythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study. Gastrointest Endosc 56:174–179PubMedCrossRef
14.
Zurück zum Zitat Czernichow P, Hochain P, Nousbaum JB et al (2000) Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur J Gastroenterol Hepatol 12:175–181PubMedCrossRef Czernichow P, Hochain P, Nousbaum JB et al (2000) Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur J Gastroenterol Hepatol 12:175–181PubMedCrossRef
15.
Zurück zum Zitat Dorward S, Sreedharan A, Leontiadis GI et al (2006) Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev CD005415 Dorward S, Sreedharan A, Leontiadis GI et al (2006) Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev CD005415
16.
Zurück zum Zitat Fernandez J, Ruiz Arbol L del, Gomez C et al (2006) Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology 131:1049–1056PubMedCrossRef Fernandez J, Ruiz Arbol L del, Gomez C et al (2006) Norfloxacin vs ceftriaxone in the prophylaxis of infections in patients with advanced cirrhosis and hemorrhage. Gastroenterology 131:1049–1056PubMedCrossRef
17.
Zurück zum Zitat Feu F, Ruiz Arbol L del, Banares R et al (1996) Double-blind randomized controlled trial comparing terlipressin and somatostatin for acute variceal hemorrhage. Variceal Bleeding Study Group. Gastroenterology 111:1291–1299PubMedCrossRef Feu F, Ruiz Arbol L del, Banares R et al (1996) Double-blind randomized controlled trial comparing terlipressin and somatostatin for acute variceal hemorrhage. Variceal Bleeding Study Group. Gastroenterology 111:1291–1299PubMedCrossRef
18.
Zurück zum Zitat Fleig WE, Lotterer E, Kleber G et al (2000) Endoskopische Therapie der oberen gastrointestinalen Blutung. Internist (Berl) 41:1031–1040 Fleig WE, Lotterer E, Kleber G et al (2000) Endoskopische Therapie der oberen gastrointestinalen Blutung. Internist (Berl) 41:1031–1040
19.
Zurück zum Zitat Forrest JA, Finlayson ND, Shearman DJ (1974) Endoscopy in gastrointestinal bleeding. Lancet 2:394–397PubMedCrossRef Forrest JA, Finlayson ND, Shearman DJ (1974) Endoscopy in gastrointestinal bleeding. Lancet 2:394–397PubMedCrossRef
20.
Zurück zum Zitat Frossard JL, Spahr L, Queneau PE et al (2002) Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial. Gastroenterology 123:17–23PubMedCrossRef Frossard JL, Spahr L, Queneau PE et al (2002) Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial. Gastroenterology 123:17–23PubMedCrossRef
21.
Zurück zum Zitat García-Pagán JC, Caca K, Bureau C et al (2010) Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 362:2370–2379PubMedCrossRef García-Pagán JC, Caca K, Bureau C et al (2010) Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 362:2370–2379PubMedCrossRef
22.
Zurück zum Zitat Gevers AM, De Goede E, Simoens M et al (2002) A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc 55:466–469PubMedCrossRef Gevers AM, De Goede E, Simoens M et al (2002) A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc 55:466–469PubMedCrossRef
23.
Zurück zum Zitat Graham DY, Smith JL (1981) The course of patients after variceal hemorrhage. Gastroenterology 80:800–809PubMed Graham DY, Smith JL (1981) The course of patients after variceal hemorrhage. Gastroenterology 80:800–809PubMed
24.
Zurück zum Zitat Havanond C, Havanond P (2005) Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding. Cochrane Database Syst Rev CD003791 Havanond C, Havanond P (2005) Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding. Cochrane Database Syst Rev CD003791
25.
Zurück zum Zitat Hou MC, Lin HC, Liu TT et al (2004) Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology 39:746–753PubMedCrossRef Hou MC, Lin HC, Liu TT et al (2004) Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology 39:746–753PubMedCrossRef
26.
Zurück zum Zitat Hsu PI, Lo GH, Lo CC et al (2004) Intravenous pantoprazole versus ranitidine for prevention of rebleeding after endoscopic hemostasis of bleeding peptic ulcers. World J Gastroenterol 10:3666–3669PubMed Hsu PI, Lo GH, Lo CC et al (2004) Intravenous pantoprazole versus ranitidine for prevention of rebleeding after endoscopic hemostasis of bleeding peptic ulcers. World J Gastroenterol 10:3666–3669PubMed
27.
Zurück zum Zitat Hubmann R, Bodlaj G, Czompo M et al (2006) The use of self-expanding metal stents to treat acute esophageal variceal bleeding. Endoscopy 38:896–901PubMedCrossRef Hubmann R, Bodlaj G, Czompo M et al (2006) The use of self-expanding metal stents to treat acute esophageal variceal bleeding. Endoscopy 38:896–901PubMedCrossRef
28.
Zurück zum Zitat Hui WM, Ng MM, Lok AS et al (1991) A randomized comparative study of laser photocoagulation, heater probe, and bipolar electrocoagulation in the treatment of actively bleeding ulcers. Gastrointest Endosc 37:299–304PubMedCrossRef Hui WM, Ng MM, Lok AS et al (1991) A randomized comparative study of laser photocoagulation, heater probe, and bipolar electrocoagulation in the treatment of actively bleeding ulcers. Gastrointest Endosc 37:299–304PubMedCrossRef
29.
Zurück zum Zitat Jensen DM, Pace SC, Soffer E et al (2006) Continuous infusion of pantoprazole versus ranitidine for prevention of ulcer rebleeding: a U.S. multicenter randomized, double-blind study. Am J Gastroenterol 101:1991–1999PubMedCrossRef Jensen DM, Pace SC, Soffer E et al (2006) Continuous infusion of pantoprazole versus ranitidine for prevention of ulcer rebleeding: a U.S. multicenter randomized, double-blind study. Am J Gastroenterol 101:1991–1999PubMedCrossRef
30.
Zurück zum Zitat Kahi CJ, Jensen DM, Sung JJ et al (2005) Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology 129:855–862PubMedCrossRef Kahi CJ, Jensen DM, Sung JJ et al (2005) Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology 129:855–862PubMedCrossRef
31.
Zurück zum Zitat Khuroo MS, Khuroo NS, Farahat KL et al (2005) Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Aliment Pharmacol Ther 21:347–361PubMedCrossRef Khuroo MS, Khuroo NS, Farahat KL et al (2005) Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding. Aliment Pharmacol Ther 21:347–361PubMedCrossRef
32.
Zurück zum Zitat Khuroo MS, Yattoo GN, Javid G et al (1997) A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med 336:1054–1058PubMedCrossRef Khuroo MS, Yattoo GN, Javid G et al (1997) A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med 336:1054–1058PubMedCrossRef
33.
Zurück zum Zitat Lai KH, Peng SN, Guo WS et al (1994) Endoscopic injection for the treatment of bleeding ulcers: local tamponade or drug effect? Endoscopy 26:338–341PubMedCrossRef Lai KH, Peng SN, Guo WS et al (1994) Endoscopic injection for the treatment of bleeding ulcers: local tamponade or drug effect? Endoscopy 26:338–341PubMedCrossRef
34.
Zurück zum Zitat Laine L, Cook D (1995) Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med 123:280–287PubMed Laine L, Cook D (1995) Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med 123:280–287PubMed
35.
Zurück zum Zitat Laine L, McQuaid KR (2009) Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 7:33–47PubMedCrossRef Laine L, McQuaid KR (2009) Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 7:33–47PubMedCrossRef
37.
Zurück zum Zitat Lau JY, Leung WK, Wu JC et al (2007) Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 356:1631–1640PubMedCrossRef Lau JY, Leung WK, Wu JC et al (2007) Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 356:1631–1640PubMedCrossRef
38.
Zurück zum Zitat Lau JY, Sung JJ, Lam YH et al (1999) Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med 340:751–756PubMedCrossRef Lau JY, Sung JJ, Lam YH et al (1999) Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med 340:751–756PubMedCrossRef
39.
Zurück zum Zitat Lau JY, Sung JJ, Lee KK et al (2000) Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med 343:310–316PubMedCrossRef Lau JY, Sung JJ, Lee KK et al (2000) Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med 343:310–316PubMedCrossRef
40.
Zurück zum Zitat Lee JG, Turnipseed S, Romano PS et al (1999) Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 50:755–761PubMedCrossRef Lee JG, Turnipseed S, Romano PS et al (1999) Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 50:755–761PubMedCrossRef
41.
Zurück zum Zitat Leontiadis GI, Sharma VK, Howden CW (2007) Proton pump inhibitor therapy for peptic ulcer bleeding: Cochrane collaboration meta-analysis of randomized controlled trials. Mayo Clin Proc 82:286–296PubMed Leontiadis GI, Sharma VK, Howden CW (2007) Proton pump inhibitor therapy for peptic ulcer bleeding: Cochrane collaboration meta-analysis of randomized controlled trials. Mayo Clin Proc 82:286–296PubMed
42.
Zurück zum Zitat Levacher S, Letoumelin P, Pateron D et al (1995) Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. Lancet 346:865–868PubMedCrossRef Levacher S, Letoumelin P, Pateron D et al (1995) Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. Lancet 346:865–868PubMedCrossRef
43.
Zurück zum Zitat Lin HJ, Hsieh YH, Tseng GY et al (2002) A prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding. Am J Gastroenterol 97:2250–2254PubMedCrossRef Lin HJ, Hsieh YH, Tseng GY et al (2002) A prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding. Am J Gastroenterol 97:2250–2254PubMedCrossRef
44.
Zurück zum Zitat Lin HJ, Tseng GY, Perng CL et al (1999) Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding. Gut 44:715–719PubMedCrossRef Lin HJ, Tseng GY, Perng CL et al (1999) Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding. Gut 44:715–719PubMedCrossRef
45.
Zurück zum Zitat Lin HJ, Wang K, Perng CL et al (1995) Heater probe thermocoagulation and multipolar electrocoagulation for arrest of peptic ulcer bleeding. A prospective, randomized comparative trial. J Clin Gastroenterol 21:99–102PubMedCrossRef Lin HJ, Wang K, Perng CL et al (1995) Heater probe thermocoagulation and multipolar electrocoagulation for arrest of peptic ulcer bleeding. A prospective, randomized comparative trial. J Clin Gastroenterol 21:99–102PubMedCrossRef
46.
Zurück zum Zitat Liou TC, Chang WH, Wang HY et al (2007) Large-volume endoscopic injection of epinephrine plus normal saline for peptic ulcer bleeding. J Gastroenterol Hepatol 22:996–1002PubMedCrossRef Liou TC, Chang WH, Wang HY et al (2007) Large-volume endoscopic injection of epinephrine plus normal saline for peptic ulcer bleeding. J Gastroenterol Hepatol 22:996–1002PubMedCrossRef
47.
Zurück zum Zitat Lo CC, Hsu PI, Lo GH et al (2006) Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers. Gastrointest Endosc 63:767–773PubMedCrossRef Lo CC, Hsu PI, Lo GH et al (2006) Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers. Gastrointest Endosc 63:767–773PubMedCrossRef
48.
Zurück zum Zitat Lo GH, Chen WC, Wang HM et al (2009) Low-dose terlipressin plus banding ligation versus low-dose terlipressin alone in the prevention of very early rebleeding of oesophageal varices. Gut 58:1275–1280PubMedCrossRef Lo GH, Chen WC, Wang HM et al (2009) Low-dose terlipressin plus banding ligation versus low-dose terlipressin alone in the prevention of very early rebleeding of oesophageal varices. Gut 58:1275–1280PubMedCrossRef
49.
Zurück zum Zitat Longstreth GF (1995) Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 90:206–210PubMed Longstreth GF (1995) Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 90:206–210PubMed
50.
Zurück zum Zitat Longstreth GF, Feitelberg SP (1998) Successful outpatient management of acute upper gastrointestinal hemorrhage: use of practice guidelines in a large patient series. Gastrointest Endosc 47:219–222PubMedCrossRef Longstreth GF, Feitelberg SP (1998) Successful outpatient management of acute upper gastrointestinal hemorrhage: use of practice guidelines in a large patient series. Gastrointest Endosc 47:219–222PubMedCrossRef
51.
Zurück zum Zitat Lui HF, Stanley AJ, Forrest EH et al (2002) Primary prophylaxis of variceal hemorrhage: a randomized controlled trial comparing band ligation, propranolol, and isosorbide mononitrate. Gastroenterology 123:735–744PubMedCrossRef Lui HF, Stanley AJ, Forrest EH et al (2002) Primary prophylaxis of variceal hemorrhage: a randomized controlled trial comparing band ligation, propranolol, and isosorbide mononitrate. Gastroenterology 123:735–744PubMedCrossRef
52.
Zurück zum Zitat Marmo R, Rotondano G, Bianco MA et al (2003) Outcome of endoscopic treatment for peptic ulcer bleeding: Is a second look necessary? A meta-analysis. Gastrointest Endosc 57:62–67PubMedCrossRef Marmo R, Rotondano G, Bianco MA et al (2003) Outcome of endoscopic treatment for peptic ulcer bleeding: Is a second look necessary? A meta-analysis. Gastrointest Endosc 57:62–67PubMedCrossRef
53.
Zurück zum Zitat Merli M, Nicolini G, Angeloni S et al (2003) Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol 38:266–272PubMedCrossRef Merli M, Nicolini G, Angeloni S et al (2003) Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol 38:266–272PubMedCrossRef
54.
Zurück zum Zitat North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices (1988) Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 319:983–989CrossRef North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices (1988) Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med 319:983–989CrossRef
55.
Zurück zum Zitat Ohmann C, Imhof M, Ruppert C et al (2005) Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 40:914–920PubMedCrossRef Ohmann C, Imhof M, Ruppert C et al (2005) Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 40:914–920PubMedCrossRef
56.
Zurück zum Zitat Papatheodoridis GV, Goulis J, Leandro G et al (1999) Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: A meta-analysis. Hepatology 30:612–622PubMedCrossRef Papatheodoridis GV, Goulis J, Leandro G et al (1999) Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: A meta-analysis. Hepatology 30:612–622PubMedCrossRef
57.
Zurück zum Zitat Park CH, Lee SJ, Park JH et al (2004) Optimal injection volume of epinephrine for endoscopic prevention of recurrent peptic ulcer bleeding. Gastrointest Endosc 60:875–880PubMedCrossRef Park CH, Lee SJ, Park JH et al (2004) Optimal injection volume of epinephrine for endoscopic prevention of recurrent peptic ulcer bleeding. Gastrointest Endosc 60:875–880PubMedCrossRef
58.
Zurück zum Zitat Pescatore P, Jornod P, Borovicka J et al (2002) Epinephrine versus epinephrine plus fibrin glue injection in peptic ulcer bleeding: a prospective randomized trial. Gastrointest Endosc 55:348–353PubMedCrossRef Pescatore P, Jornod P, Borovicka J et al (2002) Epinephrine versus epinephrine plus fibrin glue injection in peptic ulcer bleeding: a prospective randomized trial. Gastrointest Endosc 55:348–353PubMedCrossRef
59.
Zurück zum Zitat Peter S, Wilcox CM (2008) Modern endoscopic therapy of peptic ulcer bleeding. Dig Dis 26:291–299PubMedCrossRef Peter S, Wilcox CM (2008) Modern endoscopic therapy of peptic ulcer bleeding. Dig Dis 26:291–299PubMedCrossRef
60.
Zurück zum Zitat Pinto-Marques P, Romaozinho JM, Ferreira M et al (2006) Esophageal perforation–associated risk with balloon tamponade after endoscopic therapy. Myth or reality? Hepatogastroenterology 53:536–539PubMed Pinto-Marques P, Romaozinho JM, Ferreira M et al (2006) Esophageal perforation–associated risk with balloon tamponade after endoscopic therapy. Myth or reality? Hepatogastroenterology 53:536–539PubMed
61.
Zurück zum Zitat Pohl H, Finlayson SR, Sonnenberg A et al (2005) Helicobacter pylori-associated ulcer bleeding: should we test for eradication after treatment? Aliment Pharmacol Ther 22:529–537PubMedCrossRef Pohl H, Finlayson SR, Sonnenberg A et al (2005) Helicobacter pylori-associated ulcer bleeding: should we test for eradication after treatment? Aliment Pharmacol Ther 22:529–537PubMedCrossRef
62.
Zurück zum Zitat Rockall TA, Logan RF, Devlin HB et al (1995) 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 311:222–226PubMedCrossRef Rockall TA, Logan RF, Devlin HB et al (1995) 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 311:222–226PubMedCrossRef
63.
Zurück zum Zitat Rockall TA, Logan RF, Devlin HB, Northfield TC (1996) Risk assessment after acute upper gastrointestinal haemorrhage. Gut 38:316–321PubMedCrossRef Rockall TA, Logan RF, Devlin HB, Northfield TC (1996) Risk assessment after acute upper gastrointestinal haemorrhage. Gut 38:316–321PubMedCrossRef
64.
Zurück zum Zitat Rutgeerts P, Rauws E, Wara P et al (1997) Randomised trial of single and repeated fibrin glue compared with injection of polidocanol in treatment of bleeding peptic ulcer. Lancet 350:692–696PubMedCrossRef Rutgeerts P, Rauws E, Wara P et al (1997) Randomised trial of single and repeated fibrin glue compared with injection of polidocanol in treatment of bleeding peptic ulcer. Lancet 350:692–696PubMedCrossRef
65.
Zurück zum Zitat Schepke M, Kleber G, Nurnberg D et al (2004) Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology 40:65–72PubMedCrossRef Schepke M, Kleber G, Nurnberg D et al (2004) Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology 40:65–72PubMedCrossRef
66.
Zurück zum Zitat Schmitz RJ, Sharma P, Badr AS et al (2001) Incidence and management of esophageal stricture formation, ulcer bleeding, perforation, and massive hematoma formation from sclerotherapy versus band ligation. Am J Gastroenterol 96:437–441PubMedCrossRef Schmitz RJ, Sharma P, Badr AS et al (2001) Incidence and management of esophageal stricture formation, ulcer bleeding, perforation, and massive hematoma formation from sclerotherapy versus band ligation. Am J Gastroenterol 96:437–441PubMedCrossRef
67.
Zurück zum Zitat Silverstein FE, Gilbert DA, Tedesco FJ et al (1981) The national ASGE survey on upper gastrointestinal bleeding. II. Clinical prognostic factors. Gastrointest Endosc 27:80–93PubMedCrossRef Silverstein FE, Gilbert DA, Tedesco FJ et al (1981) The national ASGE survey on upper gastrointestinal bleeding. II. Clinical prognostic factors. Gastrointest Endosc 27:80–93PubMedCrossRef
68.
Zurück zum Zitat Skok P (1998) The epidemiology of hemorrhage from the upper gastrointestinal tract in the mid-nineties–has anything changed? Hepatogastroenterology 45:2228–2233PubMed Skok P (1998) The epidemiology of hemorrhage from the upper gastrointestinal tract in the mid-nineties–has anything changed? Hepatogastroenterology 45:2228–2233PubMed
69.
Zurück zum Zitat Song SY, Chung JB, Moon YM et al (1997) Comparison of the hemostatic effect of endoscopic injection with fibrin glue and hypertonic saline-epinephrine for peptic ulcer bleeding: a prospective randomized trial. Endoscopy 29:827–833PubMedCrossRef Song SY, Chung JB, Moon YM et al (1997) Comparison of the hemostatic effect of endoscopic injection with fibrin glue and hypertonic saline-epinephrine for peptic ulcer bleeding: a prospective randomized trial. Endoscopy 29:827–833PubMedCrossRef
70.
Zurück zum Zitat Sung JJ, Barkun A, Kuipers EJ et al (2009) Intravenous esomeprazole for prevention of recurrent peptic ulcer bleeding: a randomized trial. Ann Intern Med 150:455–464PubMed Sung JJ, Barkun A, Kuipers EJ et al (2009) Intravenous esomeprazole for prevention of recurrent peptic ulcer bleeding: a randomized trial. Ann Intern Med 150:455–464PubMed
71.
Zurück zum Zitat Tan PC, Hou MC, Lin HC et al (2006) A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology 43:690–697PubMedCrossRef Tan PC, Hou MC, Lin HC et al (2006) A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N-butyl-2-cyanoacrylate injection versus band ligation. Hepatology 43:690–697PubMedCrossRef
72.
Zurück zum Zitat Thomopoulos KC, Theocharis GJ, Vagenas KA et al (2004) Predictors of hemostatic failure after adrenaline injection in patients with peptic ulcers with non-bleeding visible vessel. Scand J Gastroenterol 39:600–604PubMedCrossRef Thomopoulos KC, Theocharis GJ, Vagenas KA et al (2004) Predictors of hemostatic failure after adrenaline injection in patients with peptic ulcers with non-bleeding visible vessel. Scand J Gastroenterol 39:600–604PubMedCrossRef
73.
Zurück zum Zitat Tripathi D, Ferguson JW, Kochar N et al (2009) Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology 50:825–833PubMedCrossRef Tripathi D, Ferguson JW, Kochar N et al (2009) Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology 50:825–833PubMedCrossRef
74.
Zurück zum Zitat Vergara M, Calvet X, Gisbert JP (2007) Epinephrine injection versus epinephrine injection and a second endoscopic method in high risk bleeding ulcers. Cochrane Database Syst Rev CD005584 Vergara M, Calvet X, Gisbert JP (2007) Epinephrine injection versus epinephrine injection and a second endoscopic method in high risk bleeding ulcers. Cochrane Database Syst Rev CD005584
75.
Zurück zum Zitat Vreeburg EM, Terwee CB, Snel P et al. (1999) Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 44:331–335PubMedCrossRef Vreeburg EM, Terwee CB, Snel P et al. (1999) Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 44:331–335PubMedCrossRef
76.
Zurück zum Zitat Walker S, Kreichgauer HP, Bode JC (1992) Terlipressin vs. somatostatin in bleeding esophageal varices: a controlled, double-blind study. Hepatology 15:1023–1030PubMedCrossRef Walker S, Kreichgauer HP, Bode JC (1992) Terlipressin vs. somatostatin in bleeding esophageal varices: a controlled, double-blind study. Hepatology 15:1023–1030PubMedCrossRef
77.
Zurück zum Zitat Wong SK, Yu LM, Lau JY et al (2002) Prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer. Gut 50:322–325PubMedCrossRef Wong SK, Yu LM, Lau JY et al (2002) Prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer. Gut 50:322–325PubMedCrossRef
78.
Zurück zum Zitat Yuan Y, Wang C, Hunt RH (2008) Endoscopic clipping for acute nonvariceal upper-GI bleeding: a meta-analysis and critical appraisal of randomized controlled trials. Gastrointest Endosc 68:339–351PubMedCrossRef Yuan Y, Wang C, Hunt RH (2008) Endoscopic clipping for acute nonvariceal upper-GI bleeding: a meta-analysis and critical appraisal of randomized controlled trials. Gastrointest Endosc 68:339–351PubMedCrossRef
79.
Zurück zum Zitat Zehetner J, Shamiyeh A, Wayand W et al (2008) Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent. Surg Endosc 22:2149–2152PubMedCrossRef Zehetner J, Shamiyeh A, Wayand W et al (2008) Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent. Surg Endosc 22:2149–2152PubMedCrossRef
Metadaten
Titel
Einteilung und Management der oberen gastrointestinalen Blutung
verfasst von
PD Dr. K. Herrlinger
Publikationsdatum
01.09.2010
Verlag
Springer-Verlag
Erschienen in
Die Innere Medizin / Ausgabe 9/2010
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-010-2590-9

Weitere Artikel der Ausgabe 9/2010

Der Internist 9/2010 Zur Ausgabe

Kongresse des BDI

Kongresse des BDI

Mitteilungen des BDI

Mitteilungen BDI

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

NSCLC: Progressionsfreies Überleben unter Osimertinib fast versiebenfacht

06.06.2024 ASCO 2024 Kongressbericht

Erste Ergebnisse der Phase-III-Studie LAURA etablieren Osimertinib als neuen Therapiestandard für Menschen mit nicht-resezierbarem, EGFR-mutiertem, nicht-kleinzelligem Lungenkarzinom im Stadium III, die nach definitiver Radiochemotherapie progressionsfrei sind. Auf der ASCO-Tagung wurden diese beeindruckenden Ergebnisse besprochen.

Hodgkin Lymphom: BrECADD-Regime übertrifft die Erwartungen

05.06.2024 ASCO 2024 Kongressbericht

Das Kombinationsregime BrECADD mit Brentuximab vedotin ermöglichte in der Studie HD21 beim fortgeschrittenen klassischen Hodgkin-Lymphom eine unerwartet hohe progressionsfreie Überlebensrate von 94,3% nach vier Jahren. Gleichzeitig war das Regime besser tolerabel als der bisherige Standard eBEACOPP.

Antikörper-Drug-Konjugat verdoppelt PFS bei Multiplem Myelom

05.06.2024 ASCO 2024 Nachrichten

Zwei Phase-3-Studien deuten auf erhebliche Vorteile des Antikörper-Wirkstoff-Konjugats Belantamab-Mafodotin bei vorbehandelten Personen mit Multiplem Myelom: Im Vergleich mit einer Standard-Tripeltherapie wurde das progressionsfreie Überleben teilweise mehr als verdoppelt.

Neuer TKI gegen CML: Höhere Wirksamkeit, seltener Nebenwirkungen

05.06.2024 Chronische myeloische Leukämie Nachrichten

Der Tyrosinkinasehemmer (TKI) Asciminib ist älteren Vertretern dieser Gruppe bei CML offenbar überlegen: Personen mit frisch diagnostizierter CML entwickelten damit in einer Phase-3-Studie häufiger eine gute molekulare Response, aber seltener ernste Nebenwirkungen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.