Endoskopische Blutstillung 2014 – nichtvariköse Blutungen

Zusammenfassung

Die endoskopische Behandlung ist heute der Standard bei nichtvariköser oberer gastrointestinaler Blutung. Etabliert sind die Injektion, mechanische und thermische Blutstillungsverfahren. Aktuell kommen neue topisch aufgebrachte Substanzen für die endoskopische Blutstillung zum Einsatz. Durch den Entzug von Flüssigkeit aus dem Blut soll das Eintreten der Blutgerinnung beschleunigt werden. Erste Fallserien können erfolgreiche Behandlungen bei Sickerblutungen oder als adjuvante Therapie in Kombination mit anderen Behandlungsverfahren demonstrieren. Für die mechanische Blutstillung stehen heute größere, dreh- und wiederverschließbare TTS Clips (Through the Scope) zur Verfügung. Ein Modell ermöglicht die Anwendung von drei Clips ohne einen Wechsel des Applikators. Die mechanische Blutstillung wird weiter bereichert durch die Möglichkeit, den Clip über das Endoskop OTSC (Over the Scope) zu applizieren. Bei aller Euphorie sind der endoskopischen Blutstillung jedoch weiterhin Grenzen gesetzt. Arterielle Gefäße > 2 mm und das Vorliegen eines schweren hämorrhagischen Schocks sollten den Endoskopiker bereits frühzeitigen zur interdisziplinären Fallbesprechung führen.

Abstract

Endoscopic treatment is the standard for nonvariceal upper gastrointestinal bleeding. Established are injection, mechanical and thermal hemostatic procedures. Currently new topically applied substances for endoscopic hemostasis become available. By withdrawal of fluid from the blood, the onset of blood clotting is accelerated. First case series could demonstrate successful treatment for oozing bleeding or as additional therapy in combination with other hemostatic procedures. Today larger, rotatable and repositionable clips TTS (Through the Scope) are available for mechanical hemostasis. One model allows the use of three clips without changing the applicator. A technical different method is the Over the Scope Clip OTSC, which could be applied after suction of the bleeding source. Despite the euphoria of endoscopic hemostasis, there are still some limitations to be known. Arterial vessels > 2 mm and the presence of severe hemorrhagic shock should lead the endoscopist to an interdisciplinary case discussion.

Schlüsselwörter

endoskopische Blutstillung - Hemospray - Clip - Endoclot - Ulkus

Key words

Endoscopic Hemostasis - Hemospray - clip - EndoClot - Ulcus

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