Clinical analysis of endoscopic treatment of non-variceal upper gastrointestinal bleeding in children
10.3760/cma.j.cn101070-20190603-00482
- VernacularTitle:内镜下治疗儿童非静脉曲张性上消化道出血的临床分析
- Author:
Guiping KONG
1
;
Mei LI
Author Information
1. 南京医科大学附属儿童医院消化科 210008
- From:
Chinese Journal of Applied Clinical Pediatrics
2020;35(19):1456-1459
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical and endoscopic findings of non-variceal upper gastrointestinal bleeding (NVUGIB) in children and to evaluate the efficacy of endoscopic treatment.Methods:A total of 56 children with NVUGIB admitted to Children′s Hospital Affiliated to Nanjing Medical University from May 2013 to April 2018 were enrolled.After admission, they were treated with endoscopic hemostasis, and they were divided into hematemesis group(8 cases), melena group(31 cases), and hematemesis + melena group(17 cases). In every group, hemoglobin level, blood transfusion rate, helicobacter pylori infection rate, source of hemorrhage, microscopic grading, hemostasis and results were statistically analyzed which they were compared with domestic and foreign studies.Results:In terms of hemoglobin level, hematemesis group was (92.00±25.66) g/L, melena group was (70.29±19.08) g/L, hematemesis + melena group (65.12±12.62) g/L.The differences among the 3 groups were statistically significant ( F=363.301, P<0.01). For blood transfusion rate, 25.00%(2/8 cases) was in hematemesis group, 74.19%(23/31 cases) was in melena group, and 94.12%(16/17 cases) was in hematemesis + melena group.There were significant differences among the 3 groups ( χ2=13.286, P=0.002). Totally, 50 cases (89.28%) were infected with Helicobacter pylori, and there were no significant differences among the 3 groups ( χ2=2.315, P=0.314). About bleeding source, 45 cases (80.35%) suffered from duodenal bulbar ulcer, 8 cases(14.28%) experienced gastric ulcer, 3/56 cases (5.35%) had gastric duodenal compound ulcer, and there were 25 cases(44.64%) with severe digestive tract bleeding.Forrest grade Ⅰa 2/56 cases [3.57%, 2/2 cases of rebleeding (100%)], Ⅰb 10/56 cases [17.85%, 2/10 cases of rebleeding (20%)], Ⅱa 3/56 cases (5.35%), Ⅱb 4/56 cases (7.14%), Ⅱc 2/56 cases (3.57%), and Ⅲ 35/56 cases (62.5%). Forty-eight cases (85.71%) accepted injection hemostasis, 2 cases (3.57%) obtained titanium clip hemostasis, 2 cases (3.57%) had injection + titanium clip hemostasis, 2 cases (3.57%) performed injection + titanium clip + electricity hemostasis, and 2 cases (3.57%) were given injection and surgical hemostasis.Totally, 52 cases (92.85%) achieved successful endoscopic hemostasis, 2 cases (3.57%) had successful second hemostasis, and 2 cases performed surgical operation (3.57%). Conclusions:In children with NVUGIB who need endoscopic hemostasis, duodenal ulcer is the main resource, Helicobacter pylori is the main cause.Children with melena are more likely to have severe bleeding and higher transfusion rate.Endoscopy is the preferred method for diagnosis and treatment.For Forrest Ⅰa and Ⅰb, the conbination of hemostasis under endoscope is more effective.
