Z Gastroenterol 2016; 54(03): 250-255
DOI: 10.1055/s-0035-1566987
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Neue Methoden zur endoskopischen Blutstillung: Fokus auf die nicht variköse Blutung

New methods for endoscopic hemostasis: focus on non-variceal gastrointestinal bleeding
J. G. Albert
,
K. H. Peiffer
Further Information

Publication History

20 July 2015

06 December 2015

Publication Date:
19 February 2016 (online)

Zusammenfassung

Die gastrointestinale Blutung (GIB) ist eine der am häufigsten vorkommenden gastroenterologischen Notfälle in der klinischen praktischen Tätigkeit. Während die Inzidenz und die Mortalität der GIB in vielen Ländern abnimmt, steigt die Zahl der endoskopischen Untersuchungen und Eingriffe. Die endoskopische Therapie von nicht varikösen gastrointestinalen Blutungen basiert derzeit auf den „klassischen“ Methoden wie die Injektion von vasoaktiven Substanzen (z. B. Epinephrin) oder Fibrinkleber, der Applikation von sog. „Through-the-scope“-Clips (TTSCs), der Argonplasmakoagulation (APC) oder der bipolaren Koagulation. Gerade für die nicht variköse Blutung sind in den letzten Jahren neue endoskopische Techniken entwickelt worden, die das Therapierepertoire bereichert haben. Die „Over-the-scope“-Clips (OTSCs) weisen eine größere Verschlussfläche auf als die TTSCs und werden zunehmend erfolgreich für die Blutstillung von ausgewählten Patienten mit schweren Ulkusblutungen eingesetzt. Hämostasepulver scheinen bei diffusen Blutungen eine Blutstillung zu erzielen. Neben einer kurzen Darstellung von etablierten „klassischen“ Methoden fokussiert sich diese Übersichtsarbeit auf neue epidemiologischen Daten und neue endoskopischen Techniken zur Blutstillung von nicht varikösen gastrointestinalen Blutungen.

Abstract

Gastrointestinal bleeding is a frequent emergency in daily clinical practice of a gastroenterologist. While incidence and mortality of gastrointestinal bleeding are decreasing in many countries, numbers of endoscopic procedures are increasing. Endoscopic therapy of non-variceal gastrointestinal bleeding is still mainly based on “classical” procedures like injection of vasoactive drugs (i. e. epinephrine) or blood derivates, application of through-the-scope hemoclips (TTSC), Argon plasma coagulation and bipolar coagulation. However, in the last years new endoscopic techniques especially for non-variceal gastrointestinal bleedings have become available and enriched our endoscopic equipment. For example, over-the-scope clips (OTSCs) surpass the size of TTSCs and have been successfully established for treatment of gastrointestinal bleeding and leak closure of fistulas and perforations. In addition, hemostatic powders were shown to achieve primary hemostasis in several cases of gastrointestinal bleeding. Besides a brief overview of “classical” endoscopic procedures for hemostasis of non-variceal gastrointestinal bleeding, this review focuses on new epidemiological data and uprising methods for endoscopic hemostasis.

 
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