Conservative Treatment for Gastrointestinal Bleeding―Noninvasive Treatment Other than Endoscopic Hemostasis and Indications for Surgery Satoshi Tanabe 1 , Mizutomo Azuma 1 , Katsunori Saigenji 1 1Department of Gastroenterology, Kitasato University East Hospital Keyword: 潰瘍出血 , 食道・胃静脈瘤出血 , 下部消化管出血 , interventional radiology(IVR) , 外科的治療 pp.529-535
Published Date 2005/4/25
DOI https://doi.org/10.11477/mf.1403100066
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Owing to advances in endoscopic hemostasis, many cases of gastrointestinal bleeding can now be controlled by conservative therapy, but some patients with shock due to massive bleeding still require surgical treatment. In patients with massive bleeding, interventional radiology(IVR)is recommended. IVR is particularly useful in patients with shock due to massive bleeding who cannot undergo endoscopic procedures because of massive clots. Once the patient's general condition has stabilized after IVR, conservative therapy can be continued or elective surgery performed. Balloon-occluded retrograde transvenous obliteration(B-RTO)is useful for the treatment of gastric varices with gastro-renal shunts. Transjugular intrahepatic portosystemic shunting(TIPS)may be the treatment of choice for patients with intractable esophagogastric varices or refractory ascites. The general condition of patients should be evaluated in close contact with radiologists or surgeons. IVR or emergency surgery should be promptly performed in patients in whom hemorrhage cannot be controlled by endoscopic procedures.

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