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Endoscopic yttrium aluminum garnet laser treatment in massive upper gastro intestinal bleeding a controlled randomized study



Endoscopic yttrium aluminum garnet laser treatment in massive upper gastro intestinal bleeding a controlled randomized study



Scandinavian Journal of Gastroenterology 16(5): 633-640



In patients with massive upper gastrointestinal bleeding the results of endoscopic control by coagulation with YAG [Y, Al, garnet]-laser were compared with the results of an active surgical approach with early operation in a controlled randomized study. The laser coagulation was done at admission in patients in whom an actively bleeding lesion was diagnosed at endoscopy. Of the 66 patients belonging to the laser group, 23 were bleeding at admission and endoscopy and in 15 of these coagulation was attempted and initial hemostasis was achieved in 14. Seven of the latter rebled and 5 of them were then operated upon with 1 postoperative death. Two patients died from bleeding esophageal varices and hepatic failure. In the patient in whom hemostasis was not achieved, an operation was done for a duodenal ulcer. Of the 43 patients belonging to the laser group and not bleeding at endoscopy, 9 patients rebled and 3 of them were operated upon, with 1 postoperative death. An additional 4 patients died in this group, 3 of bleeding esophageal varices in combination with hepatic failure and 1 of bleeding from an unknown source. Sixty-nine patients belonged to the control group and in 19 of these patients bleeding lesions were diagnosed at endoscopy. Five of these were operated upon, with 2 postoperative deaths. An additional 3 patients died of bleeding esophageal varices and hepatic failure. Of the 50 patients belonging to the control group and not bleeding at endoscopy, 8 later showed signs of recurrent bleeding. Four of them had esophageal varices and 2 died. The other 4 with recurrent bleeding were operated upon with no postoperative mortality. Thus 9 patients (5 with esophageal varices) died in the laser group and 7 (5 with esophageal varices) in the control group. There was no statistically significant difference between the 2 groups regarding mortality, need of blood transfusion or time of treatment in the hospital. The material is too small to make any definite conclusions and further studies are necessary in which laser treatment is compared with an aggressive surgical policy with early operations.

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Accession: 005359734

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