Çocuklarda üst gastrointestinal sistem kanamalarına tanısal ve tedavi edici endoskopik yaklaşımlar
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Date
2012-03-15
Authors
Ünal, Fatih
Şahin, Gülseren
Ecevit, Çiğdem Ömür
Semizel, Evren
Cebe, Ayşegül
Erdoğan, Hakan
Kasırga, Erhun
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Giriş: Çocuklarda üst gastrointestinal sistem (GİS) kanamaları her zaman ileri araştırmayı gerektiren önemli bir sorundur. Bu çalışmanın amacı çocukluk çağında üst GİS kanamalarının nedenlerini ortaya çıkarmak ve bunlara yönelik terapötik endoskopik yaklaşımlar ile bunların tedavi edici etkinliklerini retrospektif olarak incelemektir. Gereç ve Yöntem: Pediatrik gastroenteroloji bölümlerimizce takip edilen üst GİS kanamalı 139 (K/E:63/76) hasta yaş gruplarına, etyolojiye, kanamanın varislerden ve varis dışından olmasına, ilaç alım öyküsü olup olmamasına göre sınıflandırıldı. Ayrıca peptik ülseri olan hastaların kanaması Forrest sınıflandırılmasına göre değerlendirildi. Çalışmada p<0,05 altında olan değerler istatistiksel olarak anlamlı kabul edildi. Bulgular: Üst GİS kanamalarının %15,1’i varis ve %70,5’i varis dışı kaynaklıydı. Hastaların %14,4’ünde kanamanın yeri belirlenemedi. Çalışma grubumuzda bulunan hastaların %26,6’sında ilaç kullanım öyküsü vardı. İlaç kullanım öyküsü en sık 3-9 yaş grubu hastalarda görüldü (%25,9). Üst GİS kanaması olan 60 hastaya etyolojilerine göre endoskopik bant ligasyonu (%23,3), endoskopik skleroterapi (%10), endoskopik hemoklips (%25), epinefrin enjeksiyonu (%30), polipektomi (%5) ve koterizasyon (%6,7) gibi işlemler uygulandı. Kanamayı durdurma bakımından endoskopik hemoklips ve epinefrin uygulamaları arasında istatistiksel bir farklılık yoktu (p>0,68). Sonuç: Endoskopinin çocukluk dönemi üst GİS kanamanın etyolojisinin aydınlatılmasında ve kanamanın tedavisinde son derece yararlı olduğu düşünüldü.
Introduction: Upper gastrointestinal system bleeding in children is always very important problems requiring further investigation. The aim of the study was to investigate retrospectively the etiologies of upper gastrointestinal bleeding, the therapeutic endoscopic approach to the bleeding, and the efficacy of the endoscopy in the treatment of pediatric age group. Materials and Methods: In this study, 139 (F/M: 63/76) cases diagnosed as upper gastrointestinal bleeding and followed up by the Department of Pediatric Gastroenterology were classified into groups according to the age, etiology, the presence of varicose veins, and history of drug ingestion. In addition bleedings caused by peptic ulcer disease were classified according to Forrest classification. Values of p<0.05 were of considered as significant. Results: Upper gastrointestinal bleedings were originated from varicose veins in 15.1% of patients and non-variceal origin in 70.5% of patients. The location of bleeding could not be determined in 14.4% of the patients. The history of drug ingestion was obtained most commonly between 3-9 ages. Sixty patients underwent the procedures of endoscopic band ligation (23.3%), endoscopic sclerotherapy (10%), endoscopic hemoclips application (25%), epinephrine injection (30%), polipectomy (5%), and cauterization (6.7%) according to the etiology. In terms of stopping the bleeding, there was no statistically significant difference between endoscopic hemoclips application and epinephrine injection (p>0.68). Discussion: Endoscopic procedure is very useful in both the determination of etiology of upper gastrointestinal bleeding and the treatment of upper gastrointestinal bleeding in childhood.
Introduction: Upper gastrointestinal system bleeding in children is always very important problems requiring further investigation. The aim of the study was to investigate retrospectively the etiologies of upper gastrointestinal bleeding, the therapeutic endoscopic approach to the bleeding, and the efficacy of the endoscopy in the treatment of pediatric age group. Materials and Methods: In this study, 139 (F/M: 63/76) cases diagnosed as upper gastrointestinal bleeding and followed up by the Department of Pediatric Gastroenterology were classified into groups according to the age, etiology, the presence of varicose veins, and history of drug ingestion. In addition bleedings caused by peptic ulcer disease were classified according to Forrest classification. Values of p<0.05 were of considered as significant. Results: Upper gastrointestinal bleedings were originated from varicose veins in 15.1% of patients and non-variceal origin in 70.5% of patients. The location of bleeding could not be determined in 14.4% of the patients. The history of drug ingestion was obtained most commonly between 3-9 ages. Sixty patients underwent the procedures of endoscopic band ligation (23.3%), endoscopic sclerotherapy (10%), endoscopic hemoclips application (25%), epinephrine injection (30%), polipectomy (5%), and cauterization (6.7%) according to the etiology. In terms of stopping the bleeding, there was no statistically significant difference between endoscopic hemoclips application and epinephrine injection (p>0.68). Discussion: Endoscopic procedure is very useful in both the determination of etiology of upper gastrointestinal bleeding and the treatment of upper gastrointestinal bleeding in childhood.
Description
Keywords
Kanama, Endoskopi, Hemoklips, Bleeding, Endoscopy, Hemoclips
Citation
Ünal, F. vd. (2012). "Çocuklarda üst gastrointestinal sistem kanamalarına tanısal ve tedavi edici endoskopik yaklaşımlar". Güncel Pediatri, 10(1), 1-7.