Endoskopische Blutstillungstechniken

Das Beherrschen hämostatischer Verfahren umfasst eine rationale, rasch zum Ziel führende Diagnostik und die Einschätzung, ob und mit welcher Methodik Blutungen im Gastrointestinaltrakt therapiert werden können. Hierzu gibt es neben bereits lang zur Verfügung stehenden Verfahren auch neue Methoden, z. B. blutstillende Sprays und moderne mechanische Verfahren. Nachfolgend sollen derzeit vorliegende Erkenntnisse zum klinischen Nutzen dieser Methoden erörtert werden.

Schlüsselwörter

Blutung - Gastrointestinaltrakt - Blutstillung - endoskopisch

• Literatur

• 1 Götz M, Anders M, Biecker E. et al. [S2k Guideline Gastrointestinal Bleeding – Guideline of the German Society of Gastroenterology DGVS]. Z Gastroenterol 2017; 55: 883-936
• 2 Denzer U, Beilenhoff U, Eickhoff A. et al. [S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021–022]. Z Gastroenterol 2015; 53: E1-E227
• 3 Meier B, Wannhoff A, Denzer U. et al. Over-the-scope-clips versus standard treatment in high-risk patients with acute non-variceal upper gastrointestinal bleeding: a randomised controlled trial (STING-2). Gut 2022; 71: 1251-1258
• 4 Götz M, Biecker E, Dechêne A. et al. Addendum zur S2k-Leitlinie Gastrointestinale Blutungen der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 2022; 60: 1139-1145
• 5 Holster IL, van Beusekom HM, Kuipers EJ. et al. Effects of a hemostatic powder hemospray on coagulation and clot formation. Endoscopy 2015; 47: 638-645
• 6 Kwek BEA, Ang TL, Ong PLJ. et al. TC-325 versus the conventional combined technique for endoscopic treatment of peptic ulcers with high-risk bleeding stigmata: A randomized pilot study. J Dig Dis 2017; 18: 323-329
• 7 Beg S, Al-Bakir I, Bhuva M. et al. Early clinical experience of the safety and efficacy of EndoClot in the management of non-variceal upper gastrointestinal bleeding. Endosc Int Open 2015; 3: E605-E609
• 8 Prei JC, Barmeyer C, Bürgel N. et al. EndoClot Polysaccharide Hemostatic System in Nonvariceal Gastrointestinal Bleeding: Results of a Prospective Multicenter Observational Pilot Study. J Clin Gastroenterol 2016; 50: e95-e100
• 9 Subramaniam S, Kandiah K, Thayalasekaran S. et al. Haemostasis and prevention of bleeding related to ER: The role of a novel self-assembling peptide. United European Gastroenterol J 2019; 7: 155-162
• 10 Uraoka T, Uedo N, Oyama T. et al. Efficacy and Safety of a Novel Hemostatic Peptide Solution During Endoscopic Submucosal Dissection: A Multicenter Randomized Controlled Trial. Am J Gastroenterol 2023; 118: 276-283
• 11 Werner CR, Brücklmeier L, Kratt T. et al. Analysis on the healing of gastrointestinal ulceration by using Hemospray. Sci Rep 2021; 11: 19050
• 12 Gralnek IM, Stanley AJ, Morris AJ. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 1-46
• 13 Huang SP, Wang HP, Lee YC. et al. Endoscopic hemoclip placement and epinephrine injection for Mallory-Weiss syndrome with active bleeding. Gastrointest Endosc 2002; 55: 842-846
• 14 Swanson E, Mahgoub A, MacDonald R. et al. Medical and endoscopic therapies for angiodysplasia and gastric antral vascular ectasia: a systematic review. Clin Gastroenterol Hepatol 2014; 12: 571-582
• 15 Chen YI, Wyse J, Lu Y. et al. TC-325 hemostatic powder versus current standard of care in managing malignant GI bleeding: a pilot randomized clinical trial. Gastrointest Endosc 2020; 91: 321-328.e1
• 16 Hussein M, Alzoubaidi D, Serna A. et al. Outcomes of Hemospray therapy in the treatment of intraprocedural upper gastrointestinal bleeding post-endoscopic therapy. United European Gastroenterol J 2020; 8: 1155-1162
• 17 Libânio D, Pimentel-Nunes P, Bastiaansen B. et al. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023; 55: 361-389
• 18 Kikuchi D, Iizuka T, Makino S. et al. Utility of autologous fibrin glue and polyglycolic acid sheet for preventing delayed bleeding associated with antithrombotic therapy after gastric ESD. Endosc Int Open 2019; 7: E1542-E1548
• 19 Ferlitsch M, Hassan C, Bisschops R. et al. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2024. Endoscopy 2024; 56: 516-545