Evaluate The Clinical Value Of Endoscopic Tissue Adhesive Injection In Treatment Of Upper Gastrointestinal Hemorrhage(Variceal And Non-variceal)

Part 1 Evaluate the clinical value of endoscopic tissue adhesive injection in treatment of upper gastrointestinal hemorrhage(variceal and non-variceal)Objective:Upper gastrointestinal hemorrhage is a common acute and serve disease in clinic.The cause of hemorrhage include esophagogastric variceal bleeding,gastrointestinal ulcers,acute gasitric mucosal lesion and so on,it’s important to prevent bleeding as fast as we can..Endoscopic tissue adhesive injection is a kind of common and effective method in clinic.In this paper,115 cases of upper gastrointestinal variceal receive treatment from Xin Hua Gastroenterology of endoscopic department to evaluate the clinical value of endoscopic tissue adhesive injection in treatment of upper gastrointestinal hemorrhage from January 2016 to November 2016.Methods: We performed a retrospective analysis of data from 115 upper gastrointestinal hemorrhage patients in Xin Hua Gastroenterology of endoscopic department.The patients were divided into 5 groups as follows based on the endoscopy treatments and the cause of upper gastrointestinal hemorrhage:(1)Group A:The patients who only received endoscopic variceal ligation(EVL)with variceal hemorrhage;(2)Group B:The patients who only received tissue adhesive injection with variceal hemorrhage;(3)Group C:The patients who both received endoscopic variceal ligation and tissue adhesive injection treatment with variceal hemorrhage;(4)Group 4: The patients who only received tissue adhesive injection with nono-variceal hemorrhage;(5)Group 5 : The patients who only received forceps treatment in hemorrhage disease.To retrospective the difference of achieved hemostasis rate,early rebleeding rate,short-term complications rate,1-year mortality rate and so on.Results: There were 26 cases in Group A received 28 treatments for all,achieved hemostasis rate was 78.57%(22/28),early rebleeding rate was 17.86%(5/28),short-term complications(fever,rebleeding,perforation,embolism et al)rate was 3.57%(1/28),1-year mortality rate was 7.14(2/28);There were 15 cases in Group B received 17 treatments for all,achieved hemostasis rate was 88.24%(15/17),early rebleeding rate was 0%(0/17),short-term complications rate was 11.76%(2/17),1-year mortality rate was 0%(0/17);There were 44 cases in Group C received 90 treatments for all,achieved hemostasis rate was 94.44%(85/90),early rebleeding rate was 2.22%(2/90),short-term complications rate was 7.78%(7/90),1-year mortality rate was 0%(0/17);The Chi-square test between Group A,Group B and Group C with achieved hemostasis rate,early rebleeding rate,short-term complications rate,1-year mortality rate,a=0.05,P=0.043<0.05、P=0.0030<0.05、P=0.580>0.05、P=0.021<0.05,Statistical significance was found in achieved hemostasis rate,early rebleeding rate,,1-year mortality rate between Group A,Group B and Group C,mean the patients who both received endoscopic variceal ligation and tissue adhesive injection treatment with variceal hemorrhage were better than the patients who only received single treatment.Statistical significance was not found in short-term complications rate between Group A,Group B and Group C refer to received endoscopic variceal ligation and tissue adhesive injection treatment was not increase the risk of treatment.There were 29 cases in Group D received 29 treatments for all,achieved hemostasis rate was 92.31%(12/13)in Ia,100%(5/5)in Ib,90%(9/10)in IIa and 100%(1/1)in IIb;early rebleeding rate was 15.38%(2/13)in Ia,0%(0/5)in Ib,10%(1/10)in IIa and 0%(0/1)in IIb;short-term complications rate was 7.69%(1/13)in Ia,0%(0/5)in Ib,0%(0/10)in IIa and 0%(0/1);1-year mortality rate was 0% in Group D.Conclusion: 1.The main cause of upper gastrointestinal hemorrhage disease was divided into variceal and non-variceal hemorrhage.Liver cirrhosis lead to portal hypertension cause variceal hemorrhage,the most common disease was Hepatitis B Liver cirrhosis in our study.Gastrointestinal ulcers was the most common disease in non-variceal hemorrhage.2.In this paper,58 patients were received treatment from emergency endoscopy,57 patients were received treatment from selective endoscopy.The esophageal varices patients were received endoscopic variceal ligation to prevent bleeding,The gastric varices and gastrointestinal ulcers patients were received tissue adhesive injection to prevent bleeding.3.Statistical significance was found in achieved hemostasis rate,early rebleeding rate,,1-year mortality rate between Group A,Group B and Group C,mean the patients who both received endoscopic variceal ligation and tissue adhesive injection treatment with variceal hemorrhage were better than the patients who only received single treatment.Statistical significance was not found in short-term complications rate between Group A,Group B and Group C refer to received endoscopic variceal ligation and tissue adhesive injection treatment was not increase the risk of treatment.4.Endoscopic tissue adhesive injection in the treatment of non--variceal hemorrhage patients was effective and can prevent rebleeding.Doctors should be careful to decrease the complications rate,like venous thrombosis et al.Part 2 The study of Portal hypertensive gastropathy(PHG)after treating the patients of gastric varice by endoscopic injection of tissue adhesiveObjective To investigate the influence of portal hypertensive gastropathy(PHG)after treating the patients of gastric varice by endoscopic injection of tissue adhesive.Methods The decompensated hepatitis B cirrhosis patients with gastric varices or isolated gastric varice were gathered in our hospital during January,2013 and August,2015.Using sclerosant+ tissue adhesive+ sclerosant,the improved "sandwich" therapy.Patients were followed up in first 3 months,6 months,and 1 year after treatment.To observed the clinical efficacy of the endoscopy treatment and the change of incidence in PHG.Results There were 171 patients received sclerotherapy 242 times in endoscopy.All treatments were success.Before treatments,the incidence of PHG were 35.5%,in first 3 months were 38.1%,the incidence rate was not significantly different(P>0.05);the incidence of PHG were 48.0% in 6 months,and 84.2% in 1 year,was significantly different with patients who were not received treatments.Conclusions The endoscopic injection of tissue adhesive to the patient of gastric varice can decrease the death rate in acute hemorrhage obviously,increase the survival time.With the time goes by,the incidence of PHG was increased obviously.To improve the life quality and survival rate of patients with PHG,we need multiple combination therapies to decrease the incidence of PHG.