Original Article
Endoscopic Retreatment Compared with Surgery in Patients with Recurrent Bleeding after Initial Endoscopic Control of Bleeding Ulcers
N Engl J Med 1999; 340:751-756March 11, 1999
- Abstract
Background and Methods
After endoscopic treatment to control bleeding of peptic ulcers, bleeding recurs in 15 to 20 percent of patients. In a prospective, randomized study, we compared endoscopic retreatment with surgery after initial endoscopy. Over a 40-month period, 1169 of 3473 adults who were admitted to our hospital with bleeding peptic ulcers underwent endoscopy to reestablish hemostasis. Of 100 patients with recurrent bleeding, 7 patients with cancer and 1 patient with cardiac arrest were excluded from the study; 48 patients were randomly assigned to undergo immediate endoscopic retreatment and 44 were assigned to undergo surgery. The type of operation used was left to the surgeon. Bleeding was considered to have recurred in the event of any one of the following: vomiting of fresh blood, hypotension and melena, or a requirement for more than four units of blood in the 72-hour period after endoscopic treatment.
Results
Of the 48 patients who were assigned to endoscopic retreatment, 35 had long-term control of bleeding. Thirteen underwent salvage surgery, 11 because retreatment failed and 2 because of perforations resulting from thermocoagulation. Five patients in the endoscopy group died within 30 days, as compared with eight patients in the surgery group (P=0.37). Seven patients in the endoscopy group (including 6 who underwent salvage surgery) had complications, as compared with 16 in the surgery group (P=0.03). The duration of hospitalization, the need for hospitalization in the intensive care unit and the resultant duration of that stay, and the number of blood transfusions were similar in the two groups. In multivariate analysis, hypotension at randomization (P=0.01) and an ulcer size of at least 2 cm (P=0.03) were independent factors predictive of the failure of endoscopic retreatment.
Conclusions
In patients with peptic ulcers and recurrent bleeding after initial endoscopic control of bleeding, endoscopic retreatment reduces the need for surgery without increasing the risk of death and is associated with fewer complications than surgery.
Media in This Article
Table 1
Base-Line Characteristics of the Patients.Table 2
Outcomes after Endoscopic Retreatment or Surgery.Article Activity
- Article
Bleeding peptic ulcer is a life-threatening emergency with a mortality rate of around 10 percent.1,2 Endoscopic therapy is the first treatment to control hemorrhage, and it improves the outcome for patients.3,4 In 15 to 20 percent of patients, bleeding recurs after hemostasis has been established by endoscopy. Such patients are often elderly and at high surgical risk, and they are likely to benefit if endoscopy is repeated with satisfactory results. Conversely, the hypotension and delay in reestablishing hemostasis that result from repeated but unsuccessful endoscopic attempts are likely to adversely affect their survival. We compared endoscopic retreatment with surgery in patients in whom bleeding recurred after initial endoscopic control of bleeding peptic ulcers.
Methods
Design and Protocol of the Study
The protocol for this prospective, randomized trial was approved by the ethics committee of the faculty of medicine of the Chinese University of Hong Kong and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all patients or their next of kin.
From December 1994 to April 1998, a total of 3473 adults with bleeding peptic ulcers were admitted to the Prince of Wales Hospital. All patients were jointly cared for by medical and surgical gastroenterologists according to a standard protocol. All patients underwent endoscopy within 12 hours after admission. Patients with circulatory instability and those who were vomiting fresh blood on admission underwent emergency endoscopy.
Endoscopic therapy was performed with the use of topical pharyngeal anesthesia supplemented by intravenous emulsified diazepam (Diazemuls, Pharmacia & Upjohn, Stockholm, Sweden). A twin-channel endoscope (model GIF-2T-200, Olympus, Tokyo, Japan) was used for actively bleeding ulcers and ulcers with nonbleeding visible vessels. Clots on ulcer floors were lifted, and underlying vessels were treated when present. Ulcers were first injected with epinephrine (dilution, 1:10,000) in aliquots of 0.5 to 1 ml with a 21-gauge needle. Coaptive thermocoagulation, which involves the compression of two vessel walls, was then applied to the vessel with a 3.2-mm heater probe (model CD-10Z, Olympus) at 30 J. A minimum of three continuous pulses was applied. Hemostasis was considered to have been established and endoscopy successful if active bleeding stopped and there was flattening, or cavitation, of bleeding vessels. Antral-biopsy specimens were obtained to determine whether Helicobacter pylori was present with the use of a rapid urease test (CLO test, Delta West, Bentley, Australia).
After treatment, patients were returned to a surgical ward for monitoring. Intravenous acid-suppression agents were not routinely prescribed. A policy of early initiation of oral feeding and medication was followed. A one-week course of oral omeprazole (Losec, Astra, Mölndal, Sweden), amoxicillin (Amoxil, Bristol-Myers Squibb, Sermoneta, Italy), and clarithromycin (Klacid, Abbott, Kent, United Kingdom) was given if the rapid urease test was positive, and a four-week course of oral omeprazole was given if the test was negative. The hemoglobin level was checked daily, and transfusions were given when necessary to maintain the hemoglobin level at 10 g per deciliter or higher.
Bleeding was considered to have recurred in the event of any of the following: vomiting of fresh blood, the development of hypotension (defined as systolic blood pressure of 90 mm Hg or less or a pulse rate of 110 per minute or more) and melena, or a requirement for more than four units of blood in the 72-hour period after endoscopic treatment. Patients who satisfied any of these criteria were eligible for the trial. Only patients who were dying of cancer were excluded. When a patient was judged by his or her physician to have recurrent bleeding, the physician contacted one of the investigators or the research office at the department of surgery. Once the patient's eligibility was verified, the patient was randomly assigned by means of an opaque, sealed envelope to undergo either endoscopic retreatment or surgery. The patient was then immediately transferred to the endoscopy suite or operating room, depending on the treatment assigned. For patients assigned to endoscopic retreatment, the combination of epinephrine injection and thermocoagulation was again used. For those assigned to surgery, the choice of operation was left to the surgeon. Intravenous treatment with 40 mg of omeprazole every 12 hours was given to patients after endoscopic retreatment and to those in the surgery group who underwent simple ulcer plication or excision alone until they resumed an oral diet.
Outcome variables included the duration of hospitalization after treatment, the need for hospitalization in the intensive care unit, the need for blood transfusion, treatment-related complications, and 30-day mortality. Treatment-related complications included any complications that developed after endoscopic retreatment and subsequent salvage surgery.
Statistical Analysis
The rate of death related to failed endoscopic treatment ranges from 15 to 25 percent.5-7 Data are lacking on mortality rates after endoscopic retreatment and after salvage surgery for failed endoscopy. We estimated that approximately 30 percent of patients who were admitted with bleeding ulcers would require endoscopic treatment. If the rate of recurrent bleeding is assumed to be 10 percent among those treated, then a pool of 3000 patients would be required to recruit 90 patients into this trial. A minimum of 42 patients was required in each group for the study to have a power of 80 percent to detect an absolute reduction of 30 percent (from 45 percent to 15 percent) in mortality with a type I error of 5 percent (two-sided). The end-point data were analyzed according to the intention-to-treat principle. Fisher's exact test and Pearson's chi-square test were used to analyze categorical data.8 Factors that could be used to predict the failure of endoscopic retreatment were identified by univariate analysis. These variables were then entered into a stepwise, multiple logistic-regression analysis.9 All P values were two-tailed. A P value of less than 0.05 was considered to indicate statistical significance.
Results
Of the 3473 patients with bleeding peptic ulcers who were admitted to the hospital during the study period, 1169 (33.7 percent) underwent endoscopy to reestablish hemostasis. Hemostasis was not achieved in 17 patients (1.5 percent), and these patients went directly to surgery. Bleeding recurred in 100 patients (8.7 percent). Six of these patients did not undergo randomization, five because of terminal cancer and one because of cardiac arrest. Two patients with malignant ulcers were excluded after randomization, leaving 92 patients for analysis, 48 of whom were assigned to endoscopic retreatment and 44 to surgery.
Characteristics of the Patients
There were no significant differences between the two groups with respect to demographic characteristics, the site and size of ulcers, the severity of bleeding, and the interval between endoscopy and the recurrence of bleeding (Table 1Table 1
Base-Line Characteristics of the Patients.). Twenty-five patients in each group had hypotension at entry into the trial. The median transfusion requirement before randomization was similar in the two groups (about five units). Patients assigned to surgery had significantly more epinephrine injected (mean volume, 11.1 ml vs. 14.3 ml; P=0.04) during the initial endoscopy than those assigned to endoscopic retreatment, but the number of heater-probe pulses used was similar (median, 8 vs. 9; P=0.35). More patients had used nonsteroidal antiinflammatory drugs in the endoscopy group than in the surgery group, but the difference was not significant (21 vs. 10, P=0.05).Endoscopic Retreatment
At endoscopy, recurrent bleeding was confirmed in all 48 patients; spurting or oozing hemorrhage was present in 10 patients, and visible vessels or clots together with fresh blood or coffee-grounds material in the stomach were present in the other patients. A mean (±SD) of 11.2±5.1 ml of epinephrine was injected, and a median of 12 pulses of the heater probe were applied (range, 3 to 33). Two of the 48 patients had perforations related to the heater probe after endoscopic retreatment (4.2 percent), as compared with 13 of the 1169 patients who underwent initial endoscopy (1.1 percent). Hemostasis could not be achieved in four patients, and pneumoperitoneum developed as a result of ulcer perforation in one patient. These five patients went directly to surgery, and none died. Of the remaining 43 patients, 8 required subsequent salvage surgery. Seven of these eight had recurrent bleeding, and one patient with an anterior duodenal ulcer had an ulcer perforation 24 hours after retreatment. Four of these eight patients died after salvage surgery.
Long-term hemostasis was achieved in 35 patients. Before the six-week follow-up, 1 of these 35 patients (who had an anastomotic ulcer) returned because of minor bleeding and was again treated endoscopically. One patient died of pneumonia.
Surgery
Among the 44 patients who were assigned to undergo surgery, 22 underwent partial gastrectomy, 12 underwent vagotomy and pyloroplasty, 8 underwent ulcer plication or simple ulcer excision alone, and 2 patients with anastomotic ulcers after a previous Polya's operation (anastomosis of the transected end of the stomach to the side of the jejunum after subtotal gastrectomy) underwent simple plication with completion of the vagotomy and revision of the partial gastrectomy, respectively. Bleeding recurred postoperatively in three patients: two patients after ulcer excision alone, in whom revision of the partial gastrectomy was required, and one patient after vagotomy and pyloroplasty, in whom bleeding was managed conservatively. Two other patients required repeated laparotomy for abdominal sepsis resulting from a duodenal-stump leak and dehiscence of pyloroplasty. Both these patients died.
Outcome, Morbidity, and Mortality
The duration of hospitalization, the need for hospitalization in the intensive care unit and the resultant duration of that stay, and transfusion requirements were similar in the two groups (Table 2Table 2
Outcomes after Endoscopic Retreatment or Surgery.). More complications were observed among the patients in the surgery group than among those assigned to endoscopic retreatment (16 vs. 7; P=0.03; odds ratio, 3.45; 95 percent confidence interval, 1.2 to 9.1). In the endoscopy group, six of the seven patients who had complications had undergone salvage surgery. The complication rate after salvage surgery was 46 percent (occurring in 6 of 13 patients). Anastomotic dehiscence, including duodenal-stump leaks, occurred in two patients in each group (Table 3Table 3
Complications within 30 Days after Endoscopic Retreatment or Surgery.).There were no significant differences in 30-day mortality (P=0.37) (Table 2). In the endoscopy group, five patients (10 percent) died within 30 days after the initial endoscopy. Four of these five patients died after salvage surgery. There were eight deaths (18 percent) in the surgery group.
Factors Predicting the Failure of Endoscopic Retreatment
The two patients with perforations caused by thermocoagulation were excluded from the analysis of factors that could be used to predict the failure of endoscopic retreatment. Thus, there were 35 patients in the group with successful long-term hemostasis and 11 patients in the group for which endoscopic retreatment was unsuccessful. The two groups were similar with respect to age, ratio of men to women, the site and size of ulcers, and transfusion requirements before randomization and after treatment (Table 4Table 4
Factors Predicting the Failure of Endoscopic Retreatment of Bleeding Ulcers.). The numbers of patients with high-risk ulcers were also similar. Patients for whom endoscopic retreatment was unsuccessful were more likely to have hypotension at randomization (P=0.004) and to have larger ulcers — at least 2 cm (P=0.04). All the patients for whom retreatment was unsuccessful had other illnesses, as compared with 22 of the patients for whom endoscopic retreatment was successful (P= 0.02 by Fisher's exact test). When these variables were entered into a stepwise, multiple logistic-regression analysis, hypotension (P=0.01) and an ulcer size of at least 2 cm (P=0.03) remained significant independent factors predictive of the failure of endoscopic retreatment.Discussion
Our trial was conducted in a specialized center with expertise in controlling bleeding peptic ulcers endoscopically. Our 8.7 percent rate of recurrent bleeding after initial endoscopy was attributed to the use of a team approach, a defined management protocol, and aggressive endoscopic treatment with combination therapy for actively bleeding ulcers and ulcers with major stigmata of bleeding, including adherent clots. In a previous randomized study, we demonstrated that the combination of epinephrine injection and thermocoagulation was more effective than epinephrine injection alone.11
Extrapolation of our results to other centers where endoscopic treatment is not administered as effectively may not be warranted. Repeated, unsuccessful attempts to restore hemostasis endoscopically could compromise the survival of patients. Salvage surgery for recurrent bleeding is associated with a mortality rate ranging from 15 to 25 percent.5-7 There is little information on the outcome of patients after endoscopic retreatment for recurrent bleeding. In our study, however, the mortality rate was less than 20 percent.
Endoscopic retreatment led to long-term hemostasis in about three quarters of the patients who had recurrent bleeding. This approach reduces the need for surgery (with attendant morbidity) without increasing mortality. Our findings challenge the view that surgery is mandatory in patients with peptic ulcers that bleed again after initial endoscopic control. Our analysis indicates that endoscopic retreatment of smaller ulcers in patients with relatively stable hemodynamics has a high rate of success. For patients with larger ulcers and therefore heavier bleeding, surgery may be a better choice than endoscopic retreatment. A logical approach in patients with larger ulcers might be to perform elective surgery before bleeding recurs, since there were substantial complications after emergency salvage surgery in these patients. In addition, the eradication of H. pylori prevents recurrence of ulcers and bleeding complications.12-14
The success of endoscopic retreatment depends to a large extent on the size of the bleeding vessel itself. Arteries in smaller ulcers are mostly submucosal and have a mean diameter of 0.5 mm. In larger, chronic ulcers, the eroded arteries are serosal and have a mean diameter of 0.9 mm.15 In a canine model, coaptive thermocoagulation was consistently effective in arteries that were less than 2.0 mm in diameter.16 In a clinical endoscopic setting, however, vessels that are larger than 1.0 mm in diameter may be difficult to seal. The median size of the bleeding arteries in our patients with recurrent bleeding was 1.0 mm (range, 0.4 to 1.35). In smaller ulcers, recurrent bleeding is usually a consequence of inadequate thermocoagulation initially, and endoscopic retreatment is worthwhile. In our study, 11 patients with high-risk ulcers located at the posterior duodenal bulb or angular notch underwent endoscopic retreatment, and long-term hemostasis was achieved in 7. Erosion into major arteries such as the gastroduodenal arteries and the left gastric arteries is uncommon, and in such cases it is unlikely that hemostasis would have been achieved at initial endoscopy.
Two patients had perforations related to the heater probe. In both patients, the ulcers were in the thin anterior wall of the duodenum. The heater probe can be used with greater safety at other sites in the gastroduodenal tract and, paradoxically, for chronic ulcers, which are often firmly attached to surrounding structures by a thick, fibrous tissue.
The rate of complications after salvage surgery was substantial: 36 percent when surgery was performed after the initial endoscopy and 46 percent when it was performed after the second endoscopy. The use of intravenous antisecretory drugs after endoscopic control of bleeding ulcers remains controversial. Recent evidence suggests that high-dose oral or intravenous omeprazole can reduce the risk of recurrent bleeding and may represent an important adjunct to endoscopic therapy.17,18 Alternative strategies of reducing the need for surgery include routine follow-up (“second look”) endoscopy and prophylactic retreatment. The results of randomized studies have been limited by the inclusion of small numbers of patients or the use of suboptimal treatment at primary endoscopy.19-22 In a recent large trial, daily endoscopy and treatment with fibrin glue reduced the incidence of recurrent bleeding.23 Daily endoscopy is, however, uncomfortable for patients and costly. Its benefits are likely to be marginal if the effectiveness of the initial treatment is increased. Scheduled retreatment may nonetheless be of value in selected high-risk patients.24 The use of a different endoscopic therapy once bleeding recurs also remains an option. There has, however, been no randomized study comparing the use of contact thermal devices, fibrin sealant, and hemoclips.
We are indebted to Miss Ly Mee Yu of the Center for Clinical Trials and Epidemiological Research, Faculty of Medicine, Chinese University of Hong Kong, for statistical advice.
Source Information
From the Departments of Surgery (J.Y.W.L., Y.L., A.C.W.C., E.K.W.N., D.W.H.L., R.C.Y.S., S.C.S.C.) and Medicine and Therapeutics (J.J.Y.S., F.K.L.C.), Prince of Wales Hospital and Chinese University of Hong Kong, Shatin, Hong Kong, China.
Address reprint requests to Dr. Chung at the Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China, or at sydneychung@cuhk.edu.hk.
- References
References
1
Gilbert DA ,Silverstein FE ,Tedesco FJ ,Buenger NK ,Persing J . The national ASGE survey on upper gastrointestinal bleeding. III. Endos-copy in upper gastrointestinal bleeding. Gastrointest Endosc 1981;94:94-1022
Rockall TA ,Logan RF ,Devlin HB ,Northfield TC . Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. BMJ 1995;311:222-226
CrossRef | Web of Science | Medline3
Sacks HS ,Chalmers TC ,Blum AL ,Berrier J ,Pagano D . Endoscopic hemostasis: an effective therapy for bleeding peptic ulcers. JAMA 1990;264:494-499
CrossRef | Web of Science | Medline4
Cook DJ ,Guyatt GH ,Salena BJ ,Laine LA . Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992;102:139-148
Web of Science | Medline5
Qvist P ,Arnesen KE ,Jacobsen CD ,Rosseland AR . Endoscopic treatment and restrictive surgical policy in the management of peptic ulcer bleeding: five years' experience in a central hospital. Scand J Gastroenterol 1994;29:569-576
CrossRef | Web of Science | Medline6
Kubba AK ,Choudari C ,Rajgopal C ,Palmer KR . The outcome of urgent surgery for major peptic ulcer haemorrhage following failed endoscopic therapy. Eur J Gastroenterol Hepatol 1996;8:1175-1178
CrossRef | Web of Science | Medline7
Lau JYW ,Wong WK ,Chan ACW , et al. Surgical rescue for failed endoscopic hemostasis in bleeding peptic ulcers: a five year audit. Gastrointest Endosc 1998;47:AB87-AB87 abstract.
Web of Science8
Altman DG. Practical statistics for medical research. London: Chapman & Hall, 1991.
9
Hosmer DW Jr, Lemeshow S. Applied logistic regression. New York: John Wiley, 1989.
10
Del Guercio LRM ,Cohn JD . Monitoring operative risk in the elderly. JAMA 1980;243:1350-1355
CrossRef | Web of Science | Medline11
Chung SS ,Lau JYW ,Sung JJY , et al. A randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. BMJ 1997;314:1307-1311
CrossRef | Web of Science | Medline12
Jaspersen D ,Koerner T ,Schorr W ,Brennenstuhl M ,Raschka C ,Hammar CH . Helicobacter pylori eradication reduces the rate of rebleeding in ulcer hemorrhage. Gastrointest Endosc 1995;41:5-7
CrossRef | Web of Science | Medline13
Rokkas T ,Karameris A ,Mavrogeorgis A ,Rallis E ,Giannikos N . Eradication of Helicobacter pylori reduces the possibility of rebleeding in peptic ulcer disease. Gastrointest Endosc 1995;41:1-4
CrossRef | Web of Science | Medline14
Sung JJ ,Leung WK ,Suen R , et al. One-week antibiotics versus maintenance acid suppression therapy for Helicobacter pylori-associated peptic ulcer bleeding. Dig Dis Sci 1997;42:2524-2528
CrossRef | Web of Science | Medline15
Swain CP ,Storey DW ,Bown SG , et al. Nature of the bleeding vessel in recurrently bleeding gastric ulcers. Gastroenterology 1986;90:595-608
Web of Science | Medline16
Johnston JH ,Jensen DM ,Auth D . Experimental comparison of endoscopic yttrium-aluminum-garnet laser, electrosurgery, and heater probe for canine gut arterial coagulation: importance of compression and avoidance of erosion. Gastroenterology 1987;92:1101-1108
Web of Science | Medline17
Khuroo MS ,Yattoo GN ,Javid G , et al. A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med 1997;336:1054-1058
Full Text | Web of Science | Medline18
Lin HJ ,Lo WC ,Lee FY ,Perng CL ,Tseng GY . A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy. Arch Intern Med 1998;158:54-58
CrossRef | Web of Science | Medline19
Rutgeerts P ,Vantrappen G ,Broeckaert L ,Coremans G ,Janssens J ,Hiele M . Comparison of endoscopic polidocanol injection and YAG laser therapy for bleeding peptic ulcers. Lancet 1989;1:1164-1167
CrossRef | Web of Science | Medline20
Villanueva C ,Balanzo J ,Torras X ,Soriano G ,Sainz S ,Vilardell F . Value of a second-look endoscopy after injection therapy for bleeding peptic ulcer: a prospective and randomized trial. Gastrointest Endosc 1994;40:34-39
CrossRef | Web of Science | Medline21
Lin CK ,Lai KH ,Lo GH , et al. The value of second-look endoscopy after endoscopic injection therapy for bleeding peptic ulcer. Gastroenterology 1996;110:Suppl:177-177 abstract.
CrossRef | Web of Science22
Messmann H ,Schaller P ,Gross V , et al. Can an early second-look endoscopy reduce recurrent bleeding of gastric or duodenal ulcers? Gastrointest Endosc 1996;43:354-354 abstract.
CrossRef23
Rutgeerts P ,Rauws E ,Wara P , et al. Randomised trial of single and repeated fibrin glue compared with injection of polidocanol in treatment of bleeding peptic ulcer. Lancet 1997;350:692-696
CrossRef | Web of Science | Medline24
Saeed ZA ,Cole RA ,Ramirez FC ,Schneider FE ,Hepps KS ,Graham DY . Endoscopic retreatment after successful initial hemostasis prevents ulcer rebleeding: a prospective randomized trial. Endoscopy 1996;28:288-294
CrossRef | Web of Science | Medline
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Citing Articles
1
Loren Laine, Dennis M Jensen. (2012) Management of Patients With Ulcer Bleeding. The American Journal of Gastroenterology
CrossRef2
Gilles Lesur, Denis Heresbach, Jean-Pierre Arpurt, Bruno Richard-Molard. (2012) Consensus en endoscopie digestive : hémostase endoscopique des hémorragies digestives hautes. Acta Endoscopica
CrossRef3
Marc Bardou, Dalila Benhaberou-Brun, Isabelle Le Ray, Alan N. Barkun. (2012) Diagnosis and management of nonvariceal upper gastrointestinal bleeding. Nature Reviews Gastroenterology & Hepatology
CrossRef4
Duncan J Stewart, Roger Ackroyd. (2011) Peptic ulcers and their complications. Surgery (Oxford) 29:11, 568-574
CrossRef5
G. Lesur, M. Sapoval. (2011) Hémorragie digestive haute : que faire en cas d’échec du traitement endoscopique premier ?. Acta Endoscopica 41:5, 273-275
CrossRef6
Constance W. Lee, George A. Sarosi. (2011) Emergency Ulcer Surgery. Surgical Clinics of North America 91:5, 1001-1013
CrossRef7
Thomas O.G. Kovacs, Dennis M. Jensen. (2011) Endoscopic Therapy for Severe Ulcer Bleeding. Gastrointestinal Endoscopy Clinics of North America 21:4, 681-696
CrossRef8
Wadie I. Najm. (2011) Peptic Ulcer Disease. Primary Care: Clinics in Office Practice 38:3, 383-394
CrossRef9
Nicholas M. Szary, Ruchi Gupta, Abhishek Choudhary, Michelle L. Matteson, Murtaza Arif, Hazem T. Hammad, Matthew L. Bechtold. (2011) Erythromycin prior to endoscopy in acute upper gastrointestinal bleeding: A meta-analysis. Scandinavian Journal of Gastroenterology 46:7-8, 920-924
CrossRef10
Ikushima Ichiro, Higashi Shushi, Ishii Akihiko, Iryo Yasuhiko, Yamashita Yasuyuki. (2011) Empiric Transcatheter Arterial Embolization for Massive Bleeding From Duodenal Ulcers: Efficacy and Complications. Journal of Vascular and Interventional Radiology 22:7, 911-916
CrossRef11
S. Mirsadraee, P. Tirukonda, A. Nicholson, S.M. Everett, S.J. McPherson. (2011) Embolization for non-variceal upper gastrointestinal tract haemorrhage: A systematic review. Clinical Radiology 66:6, 500-509
CrossRef12
Brian J. Dunkin, Kai Matthes, Dennis M. Jensen. 2011. GI Hemostasis. , 170-187.
CrossRef13
Tiffany C.L. Wong, Ka-Tak Wong, Philip W.Y. Chiu, Anthony Y.B. Teoh, Simon C.H. Yu, Kim W.L. Au, James Y.W. Lau. (2011) A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers. Gastrointestinal Endoscopy 73:5, 900-908
CrossRef14
Wei-Chou Chang, Chang-Hsien Liu, Hsian-He Hsu, Guo-Shu Huang, Ho-Jui Tung, Tsai-Yuan Hsieh, Shih-Hung Tsai, Chung-Bao Hsieh, Chih-Yung Yu. (2011) Intra-Arterial Treatment in Patients with Acute Massive Gastrointestinal Bleeding after Endoscopic Failure: Comparisons between Positive versus Negative Contrast Extravasation Groups. Korean Journal of Radiology 12:5, 568
CrossRef15
Romaric Loffroy, Pramod Rao, Shinichi Ota, Ming Lin, Byung-Kook Kwak, Jean-François Geschwind. (2010) Embolization of Acute Nonvariceal Upper Gastrointestinal Hemorrhage Resistant to Endoscopic Treatment: Results and Predictors of Recurrent Bleeding. CardioVascular and Interventional Radiology 33:6, 1088-1100
CrossRef16
Angel Lanas, Xavier Calvet, Faust Feu, Julio Ponce, Javier P. Gisbert, Alan Barkun. (2010) Primer consenso español sobre el tratamiento de la hemorragia digestiva por úlcera péptica. Medicina Clínica 135:13, 608-616
CrossRef17
R. Czymek, A. Großmann, U. Roblick, T. Jungbluth, F. Fischer, H.-P. Bruch. (2010) Die Operation als Notfalltherapie bei akuter gastrointestinaler Blutung. Der Chirurg 81:10, 922-929
CrossRef18
Vincent W.S. Wong, Francis K.L. Chan. 2010. Peptic Ulcer Disease. , 325-335.
CrossRef19
Nicholas Church, Kelvin Palmer. 2010. Acute Non-Variceal Gastrointestinal Hemorrhage: Treatment. , 165-189.
CrossRef20
K. Herrlinger. (2010) Einteilung und Management der oberen gastrointestinalen Blutung. Der Internist 51:9, 1145-1158
CrossRef21
Jie Li, Judy F. Burnham, Trey Lemley, Robert M. Britton. (2010) Citation Analysis: Comparison of Web of Science®, Scopus™, SciFinder®, and Google Scholar. Journal of Electronic Resources in Medical Libraries 7:3, 196-217
CrossRef22
Nobutsugu Abe, Hirohisa Takeuchi, Osamu Yanagida, Masanori Sugiyama, Yutaka Atomi. (2010) SURGICAL INDICATIONS AND PROCEDURES FOR BLEEDING PEPTIC ULCER. Digestive Endoscopy 22, S35-S37
CrossRef23
Takuji Kawamura, Kenjiro Yasuda, Soichiro Morikawa, Masahiro Itonaga, Masatsugu Nakajima. (2010) CURRENT STATUS OF ENDOSCOPIC MANAGEMENT FOR NONVARICEAL UPPER GASTROINTESTINAL BLEEDING. Digestive Endoscopy 22, S26-S30
CrossRef24
James Lau, Joseph J.Y. Sung. (2010) From Endoscopic Hemostasis to Bleeding Peptic Ulcers: Strategies to Prevent and Treat Recurrent Bleeding. Gastroenterology 138:4, 1252-1254.e1
CrossRef25
Mitchell S. Cappell. (2010) Therapeutic endoscopy for acute upper gastrointestinal bleeding. Nature Reviews Gastroenterology & Hepatology 7:4, 214-229
CrossRef26
Subhas Banerjee, Brooks D. Cash, Jason A. Dominitz, Todd H. Baron, Michelle A. Anderson, Tamir Ben-Menachem, Laurel Fisher, Norio Fukami, M. Edwyn Harrison, Steven O. Ikenberry, Khalid Khan, Mary Lee Krinsky, John Maple, Robert D. Fanelli, Laura Strohmeyer. (2010) The role of endoscopy in the management of patients with peptic ulcer disease. Gastrointestinal Endoscopy 71:4, 663-668
CrossRef27
S.K. Gölder, H. Messmann. (2010) Akute gastrointestinale Blutungen. Notfall + Rettungsmedizin 13:2, 159-172
CrossRef28
Loren Laine, Brennan Spiegel, Alaa Rostom, Paul Moayyedi, Ernst J Kuipers, Marc Bardou, Joseph Sung, Alan N Barkun. (2010) Methodology for Randomized Trials of Patients With Nonvariceal Upper Gastrointestinal Bleeding: Recommendations From an International Consensus Conference. The American Journal of Gastroenterology 105:3, 540-550
CrossRef29
Joseph J Y Sung. (2010) Marshall and Warren Lecture 2009: Peptic Ulcer Bleeding: An expedition of 20 years from 1989-2009. Journal of Gastroenterology and Hepatology 25:2, 229-233
CrossRef30
C Hammes, G Moersdorf, A Refeidi, S Post, G Kaehler. (2010) Endoscopic application of hemostatic thrombin-gelatin matrix (FloSeal ® ) in anticoagulated pigs. Minimally Invasive Therapy & Allied Technologies 19:1, 48-51
CrossRef31
Y Richard Wang, Joel E. Richter, Daniel T. Dempsey. (2010) Trends and Outcomes of Hospitalizations for Peptic Ulcer Disease in the United States, 1993 to 2006. Annals of Surgery 251:1, 51-58
CrossRef32
John S. Goff. 2010. Upper Gastrointestinal Tract Hemorrhage. , 355-362.
CrossRef33
Chittinad Havanond, Piyalamporn Havanond, Karin L Dearness. 2009. Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding. .
CrossRef34
Frances K.Y. Cheung, James Y.W. Lau. (2009) Management of Massive Peptic Ulcer Bleeding. Gastroenterology Clinics of North America 38:2, 231-243
CrossRef35
D. -A. Benajah, N. Aqodad, S. Fakir, M. Abkari, C. Nejjari, A. Ibrahimi. (2009) Les hémorragies digestives ulcéreuses au CHU Hassan-II de Fès: approche épidémiologique. Journal Africain d'Hépato-Gastroentérologie 3:1, 16-21
CrossRef36
Philip W.Y. Chiu, Enders K.W. Ng, Frances K.Y. Cheung, Francis K.L. Chan, W.K. Leung, Justin C.Y. Wu, Vincent W.S. Wong, M.Y. Yung, Kelvin Tsoi, James Y.W. Lau, Joseph J.Y. Sung, Sydney S.C. Chung. (2009) Predicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy. Clinical Gastroenterology and Hepatology 7:3, 311-316
CrossRef37
Il-Kwun Chung, Dong Ho Lee, Heung Up Kim, In Kyung Sung, Jin-Ho Kim, , . (2009) Guidelines of Treatment for Bleeding Peptic Ulcer Disease. The Korean Journal of Gastroenterology 54:5, 298
CrossRef38
Akihiro Tajima, Kazuhito Koizumi, Kazuyoshi Suzuki, Naoko Higashi, Morio Takahashi, Tadahito Shimada, Akira Terano, Hideyuki Hiraishi, Hajime Kuwayama. (2008) Proton pump inhibitors and recurrent bleeding in peptic ulcer disease. Journal of Gastroenterology and Hepatology 23, S237-S241
CrossRef39
Thomas O. G. Kovacs. (2008) Management of upper gastrointestinal bleeding. Current Gastroenterology Reports 10:6, 535-542
CrossRef40
Lars Aabakken. (2008) Endoscopic haemostasis. Best Practice & Research Clinical Gastroenterology 22:5, 899-927
CrossRef41
Philip W. Chiu, James Y. Lau, Enders K. Ng, Candice C. Lam, Mammie Hui, Kai Fai To, Joseph J. Sung, Sydney S. Chung. (2008) Closure of a gastrotomy after transgastric tubal ligation by using the Eagle Claw VII: a survival experiment in a porcine model (with video). Gastrointestinal Endoscopy 68:3, 554-559
CrossRef42
Luc Defreyne, Ignace Schrijver, Johan Decruyenaere, Georges Maele, Wim Ceelen, Danny Looze, Peter Vanlangenhove. (2008) Therapeutic Decision-Making in Endoscopically Unmanageable Nonvariceal Upper Gastrointestinal Hemorrhage. CardioVascular and Interventional Radiology 31:5, 897-905
CrossRef43
Gralnek, Ian M., Barkun, Alan N., Bardou, Marc, . (2008) Management of Acute Bleeding from a Peptic Ulcer. New England Journal of Medicine 359:9, 928-937
Full Text44
Andrew J. Robson, Jennifer M. J. Richards, Nicholas Ohly, Stephen J. Nixon, Simon Paterson-Brown. (2008) The Effect of Surgical Subspecialization on Outcomes in Peptic Ulcer Disease Complicated by Perforation and Bleeding. World Journal of Surgery 32:7, 1456-1461
CrossRef45
Josep M. Piqué. (2008) Introducción. Puntos clave en el abordaje de la hemorragia digestiva alta. Gastroenterología y Hepatología 31, 1-4
CrossRef46
Kelvin K.F. Tsoi, James Y.W. Lau, Joseph J.Y. Sung. (2008) Cost-effectiveness analysis of high-dose omeprazole infusion before endoscopy for patients with upper-GI bleeding. Gastrointestinal Endoscopy 67:7, 1056-1063
CrossRef47
Halina cichoż-Lach, Krzysztof Celiński, Maria Słomka. (2008) Treatment of non-variceal upper gastrointestinal tract bleeding within our experience. Annales UMCS, Medicina 63:1, 192-196
CrossRef48
Mitchell S. Cappell, David Friedel. (2008) Acute Nonvariceal Upper Gastrointestinal Bleeding: Endoscopic Diagnosis and Therapy. Medical Clinics of North America 92:3, 511-550
CrossRef49
Salman Al–Sabah, Alan N. Barkun, Karl Herba, Viviane Adam, Carlo Fallone, Serge Mayrand, Gilles Pomier–Layrargues, Wendy Kennedy, Marc Bardou. (2008) Cost-Effectiveness of Proton-Pump Inhibition Before Endoscopy in Upper Gastrointestinal Bleeding. Clinical Gastroenterology and Hepatology 6:4, 418-425
CrossRef50
Robert James Atkinson, David Paul Hurlstone. (2008) Usefulness of prognostic indices in upper gastrointestinal bleeding. Best Practice & Research Clinical Gastroenterology 22:2, 233-242
CrossRef51
Lars Aabakken. (2008) Current endoscopic and pharmacological therapy of peptic ulcer bleeding. Best Practice & Research Clinical Gastroenterology 22:2, 243-259
CrossRef52
Olivier R.C. Busch, Otto M. van Delden, Dirk J. Gouma. (2008) Therapeutic options for endoscopic haemostatic failures: the place of the surgeon and radiologist in gastrointestinal tract bleeding. Best Practice & Research Clinical Gastroenterology 22:2, 341-354
CrossRef53
D. Pateron, J.-L. Pourriat, N. Carbonell. (2008) Emorragie digestive non traumatiche dell???adulto. EMC - Anestesia-Rianimazione 13:4, 1-10
CrossRef54
Ivan Jovanovic, Dragan Popovic, Srdjan Djuranovic, Aleksandra Pavlovic, Nenad Mijalkovic, Miodrag Krstic. (2008) Upper gastrointestinal bleeding: Five-year experience from one centre. Srpski arhiv za celokupno lekarstvo 136:3-4, 116-121
CrossRef55
Mukul Rastogi, Ajay Kumar. (2007) Non Variceal Upper Gastrointestinal Bleed. Apollo Medicine 4:4, 292-296
CrossRef56
Jasmohan S. Bajaj, Kulwinder S. Dua, Kristin Hanson, Kenneth Presberg. (2007) Prospective, Randomized Trial Comparing Effect of Oral Versus Intravenous Pantoprazole on Rebleeding After Nonvariceal Upper Gastrointestinal Bleeding: A Pilot Study. Digestive Diseases and Sciences 52:9, 2190-2194
CrossRef57
Vu Kwan, Ian D. Norton. (2007) ENDOSCOPIC MANAGEMENT OF NON-VARICEAL UPPER GASTROINTESTINAL HAEMORRHAGE. ANZ Journal of Surgery 77:4, 222-230
CrossRef58
M. SIMON-RUDLER, J. MASSARD, B. BERNARD-CHABERT, V. DI MARTINO, V. RATZIU, T. POYNARD, D. THABUT. (2007) Continuous infusion of high-dose omeprazole is more effective than standard-dose omeprazole in patients with high-risk peptic ulcer bleeding: a retrospective study. Alimentary Pharmacology & Therapeutics 25:8, 949-954
CrossRef59
Victor K. Chen, Richard C. K. Wong. (2007) Endoscopic Doppler Ultrasound Versus Endoscopic Stigmata-Directed Management of Acute Peptic Ulcer Hemorrhage: A Multimodel Cost Analysis. Digestive Diseases and Sciences 52:1, 149-160
CrossRef60
Z.D. Lausevic, P.M. Pesko, S.N. Krstic, A. Sijacki, M.S. Gvozdenovic, V.M. Bumbasirevic, A.R. Karamarkovic, V.R. Resanovic, G. Kaljevic, G. Vukovic. (2007) Surgical perspectives in treatment of bleeding peptic ulcers. Acta chirurgica iugoslavica 54:1, 157-164
CrossRef61
P. Pesko, I. Jovanovic. (2007) Gastrointestinalno krvarenje - krvarenje iz gornjih delova digestivnog sistema. Acta chirurgica iugoslavica 54:1, 9-20
CrossRef62
Z.D. Lausevic, V.R. Resanovic, P.P. Pesko, S.N. Krstic, M.S. Gvozdenovic. (2007) The influence of risk factors in recurrent peptic ulcer hemorrhage. Acta chirurgica iugoslavica 54:1, 35-39
CrossRef63
I.R. Jovanovic, D. Popovic, S. Djuranovic, A.R. Pavlovic, N.S. Mijalkovic, Dj. Culafic, M.N. Krstic. (2007) Acute upper gastrointestinal bleeding. Acta chirurgica iugoslavica 54:1, 21-24
CrossRef64
S.N. Krstic, T. Alempijevic, M.N. Krstic, Z.D. Lausevic, A. Sijacki, V.R. Djukic, D. Jovanovic, B. Stefanovic, V. Arsenijevic. (2007) Surgical treatment of gastroduodenal ulcer bleeding: Our experience. Acta chirurgica iugoslavica 54:1, 165-167
CrossRef65
U. Weickert, J. F. Riemann. (2006) Management der Ulkusblutung. Der Internist 47:6, 596-601
CrossRef66
Nicholas Carbonell, Arnaud Pauwels, Lawrence Serfaty, Pierre-Yves Boelle, Laurent Becquemont, Raoul Poupon. (2006) Erythromycin Infusion Prior to Endoscopy for Acute Upper Gastrointestinal Bleeding: A Randomized, Controlled, Double-Blind Trial. The American Journal of Gastroenterology 101:6, 1211-1215
CrossRef67
R.C. Britt, L.D. Britt. 2006. Gastrointestinal Hemorrhage. .
CrossRef68
W. T. Knoefel, A. Rehders. (2006) Chirurgische Therapiekonzepte bei oberer gastrointestinaler Blutung. Der Chirurg 77:2, 126-132
CrossRef69
Joseph Sung. (2006) Current management of peptic ulcer bleeding. Nature Clinical Practice Gastroenterology & Hepatology 3:1, 24-32
CrossRef70
Yen-Chun Peng, Show-Yun Chen, Chun-Fang Tung, Wai-Keung Chou, Wei-Hsiung Hu, Dar-Yu Yang. (2006) Factors Associated With Failure of Initial Endoscopic Hemoclip Hemostasis for Upper Gastrointestinal Bleeding. Journal of Clinical Gastroenterology 40:1, 25-28
CrossRef71
Hans-Dietrich Röher, Norbert M. Bösing. 2006. Magen – Duodenum. , 429-493.
CrossRef72
J. Bendix Holme, D. Tønner Nielsen, P. Funch-Jensen, F. Viborg Mortensen. (2006) Transcatheter Arterial Embolization in Patients with Bleeding Duodenal Ulcer: An Alternative to Surgery. Acta Radiologica 47:3, 244-247
CrossRef73
Bruce E. Stabile, Brian R. Smith, David L. Weeks. (2005) Helicobacter pylori Infection and Surgical Disease—Part II. Current Problems in Surgery 42:12, 804-862
CrossRef74
Charles B. Ferguson, Robert M. Mitchell. (2005) Nonvariceal Upper Gastrointestinal Bleeding: Standard and New Treatment. Gastroenterology Clinics of North America 34:4, 607-621
CrossRef75
D. J. Park, H. -J. Lee, S. G. Kim, H. C. Jung, I. S. Song, K. U. Lee, K. J. Choe, H.-K. Yang. (2005) Intraoperative gastroscopy for gastric surgery. Surgical Endoscopy 19:10, 1358-1361
CrossRef76
X. Calvet, M. Vergara, E. Brullet. (2005) Tratamiento endoscópico de la úlcera hemorrágica: ¿todo dicho, todo hecho?. Gastroenterología y Hepatología 28:6, 347-353
CrossRef77
Chittinad Havanond, Piyalamporn Havanond, Chittinad Havanond. 2005. Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding. .
CrossRef78
Brennan M. R. Spiegel, Chiun-Fang Chiou, Joshua J. Ofman. (2005) Minimizing complications from nonsteroidal antiinflammatory drugs: Cost-effectiveness of competing strategies in varying risk groups. Arthritis & Rheumatism 53:2, 185-197
CrossRef79
L. Cipolletta, G. Rotondano, Maria Antonia Bianco, R. Marmo, R. Piscopo. (2004) Endoscopie d’urgence dans l’hémorragie digestive haute. Acta Endoscopica 34:5, 663-669
CrossRef80
Gerhard Mayer, Thomas Lingenfelser, Christian Ell. (2004) The role of endoscopy in early postoperative haemorrhage. Best Practice & Research Clinical Gastroenterology 18:5, 799-807
CrossRef81
Richard M. Warneke, Eric Walser, Sohaib Faruqi, Syed Jafri, Manoop S. Bhutani, Gottumukkala S. Raju. (2004) Cap-assisted endoclip placement for recurrent ulcer hemorrhage after repeatedly unsuccessful endoscopic treatment and angiographic embolization: case report. Gastrointestinal Endoscopy 60:2, 309-312
CrossRef82
G. Gay, G. Lesur, J. -P. Arpurt, C. Boustiere, J. Boyer, J. -M. Canard, P. -A. Dalbies, J. Escourrou, M. Greff, J. Lapuelle, R. Laugier, J. -C. Letard, B. Marchetti, B. Napoleon, L. Palazzo, T. Ponchon, D. Sautereau, B. Vedrenne. (2004) Techniques d’hémostase des ulcères gastriques et duodénaux. Acta Endoscopica 34:3, 358-360
CrossRef83
Cemalettin Ertekin, Hakan Yanar, Korhan Taviloglu, Recep Guloglu, Orhan Alimoglu. (2004) Can Endoscopic Injection of Epinephrine Prevent Surgery in Gastroduodenal Ulcer Bleeding? An Analysis of 107 Cases. Journal of Laparoendoscopic & Advanced Surgical Techniques 14:3, 147-152
CrossRef84
C Meaden, A.J Makin. (2004) Diagnosis and treatment of patients with gastrointestinal bleeding. Current Anaesthesia & Critical Care 15:2, 123-132
CrossRef85
Cristina Ripoll, Rafael Bañares, Inmaculada Beceiro, Pedro Menchén, María-Vega Catalina, Antonio Echenagusia, Fernando Turegano. (2004) Comparison of Transcatheter Arterial Embolization and Surgery for Treatment of Bleeding Peptic Ulcer after Endoscopic Treatment Failure. Journal of Vascular and Interventional Radiology 15:5, 447-450
CrossRef86
David J Exon, S.C Sydney Chung. (2004) Endoscopic therapy for upper gastrointestinal bleeding. Best Practice & Research Clinical Gastroenterology 18:1, 77-98
CrossRef87
Konstantinos C Thomopoulos, Konstantinos A Vagenas, Constantine E Vagianos, Vassilios G Margaritis, Alexandros P Blikas, Evangelos C Katsakoulis, Vassiliki N Nikolopoulou. (2004) Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years. European Journal of Gastroenterology & Hepatology 16:2, 177-182
CrossRef88
C. Mel Wilcox. 2004. Upper Gastrointestinal Bleeding. , 557-565.
CrossRef89
Shireen Andrade Pais, Russell Yang. (2003) Diagnostic and therapeutic options in the management of nonvariceal upper gastrointestinal bleeding. Current Gastroenterology Reports 5:6, 476-481
CrossRef90
Christopher S Huang, David R Lichtenstein. (2003) Nonvariceal upper gastrointestinal bleeding. Gastroenterology Clinics of North America 32:4, 1053-1078
CrossRef91
C??cile Chassaignon, Philippe Letoumelin, Dominique Pateron. (2003) Upper gastrointestinal haemorrhage in Emergency Departments in France: causes and management. European Journal of Emergency Medicine 10:4, 290-295
CrossRef92
Philip Wai-Yan Chiu, Tai-Shing Lau, Kwok-Hung Kwong, Dacita To-Ki Suen, Samuel Po-Yin Kwok. (2003) Impact of programmed second endoscopy with appropriate re-treatment on peptic ulcer re-bleeding: A systematic review. Annals of the College of Surgeons Hong Kong 7:4, 106-115
CrossRef93
Yves M. Gagnon, Adrian R. Levy, Mohamad A. Eloubeidi, Miguel R. Arguedas, Kevin P. Rioux, Robert A. Enns. (2003) Cost Implications of Administering Intravenous Proton Pump Inhibitors to All Patients Presenting to the Emergency Department with Peptic Ulcer Bleeding. Value in Health 6:4, 457-465
CrossRef94
M.E. Leerdam, E. M. Vreeburg, E.A.J. Rauws, A.A.M. Geraedts, J.G.P. Tijssen, J.B. Reitsma, G.N.J. Tytgat. (2003) Acute upper GI bleeding: did anything change?. Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. The American Journal of Gastroenterology 98:7, 1494-1499
CrossRef95
K PALMER. (2003) Haematemesis and Melaena. Medicine 31:1, 19-24
CrossRef96
Thomas O.G. Kovacs, Dennis M. Jensen. (2002) Recent advances in the endoscopic diagnosis and therapy of upper gastrointestinal, small intestinal, and colonic bleeding. Medical Clinics of North America 86:6, 1319-1356
CrossRef97
H.-J. Mischinger, H. Cerwenka, HJ. Marsoner, W. Schweiger, G. Werkgartner, H. Hauser. (2002) Gastroduodenal Ulcer Bleeding. European Surgery-Acta Chirurgica Austriaca 34:4, 220-225
CrossRef98
A. Sonnenberg, M. W. Gavin. (2002) General principles to enhance practice patterns in gastrointestinal endoscopy. Alimentary Pharmacology and Therapeutics 16:5, 1003-1009
CrossRef99
A. Repici, A. Ferrari, C. De Angelis, S. Caronna, C. Barletti, S. Paganin, A. Musso, P. Carucci, W. Debernardi-Venon, M. Rizzetto, G. Saracco. (2002) Adrenaline plus cyanoacrylate injection for treatment of bleeding peptic ulcers after failure of conventional endoscopic haemostasis. Digestive and Liver Disease 34:5, 349-355
CrossRef100
Grace H. Elta. (2002) Acute nonvariceal upper gastrointestinal hemorrhage. Current Treatment Options in Gastroenterology 5:2, 147-152
CrossRef101
Thomas Lingenfelser, Christian Ell. (2001) Gastrointestinal bleeding in the elderly. Best Practice & Research Clinical Gastroenterology 15:6, 963-982
CrossRef102
J.I.W. Jones, C.J. Hawkey. (2001) Physiology and organ-related pathology of the elderly: stomach ulcers. Best Practice & Research Clinical Gastroenterology 15:6, 943-961
CrossRef103
Guillermo de la Mora, Norman E. Marcon. (2001) Endoscopy in the elderly patient. Best Practice & Research Clinical Gastroenterology 15:6, 999-1012
CrossRef104
G. Lesur, B. Bour. (2001) Techniques d'hémostase endoscopique. Acta Endoscopica 31:S4, 589-591
CrossRef105
James J. Farrell, Lawrence S. Friedman. (2001) GASTROINTESTINAL BLEEDING IN THE ELDERLY. Gastroenterology Clinics of North America 30:2, 377-407
CrossRef106
Wahid Wassef, Jorge Obando, Ashish Sharma. (2001) Upper Gastrointestinal Bleeding of Nonvariceal Origin in the ICU Setting. Journal of Intensive Care Medicine 16:3, 105-113
CrossRef107
Robert Cowles, Michael Mulholland. (2001) Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 11:1, 2-8
CrossRef108
John G. Lee, Joseph W. Leung. (2001) Recurrent ulcer bleeding: Is the hemoclip an answer?. Gastrointestinal Endoscopy 53:2, 256-258
CrossRef109
Marc Simoens, Paul Rutgeerts. (2001) Non-variceal upper gastrointestinal bleeding. Best Practice & Research Clinical Gastroenterology 15:1, 121-133
CrossRef110
Robert A. Cowles, Michael W. Mulholland. (2001) Surgical Management of Peptic Ulcer Disease in the Helicobacter Era—Management of Bleeding Peptic Ulcer. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 11:1, 2-8
CrossRef111
Wahid Wassef, Stephen O???Keefe. (2000) Interventional procedures. Current Opinion in Gastroenterology 16:6, 508-515
CrossRef112
James Yw Lau, Sydney Chung. (2000) Management of upper gastrointestinal haemorrhage. Journal of Gastroenterology and Hepatology 15:s3, G8-G12
CrossRef113
A. Garripoli, A. Mondardini, D. Turco, P. Martinoglio, P. Secreto, A. Ferrari. (2000) Hospitalization for peptic ulcer bleeding: evaluation of a risk scoring system in clinical practice. Digestive and Liver Disease 32:7, 577-582
CrossRef114
Shawn Mallery, Jacques Van Dam. (2000) ADVANCES IN DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY. Medical Clinics of North America 84:5, 1059-1083
CrossRef115
Marc A. Fallah, Chandra Prakash, Steven Edmundowicz. (2000) ACUTE GASTROINTESTINAL BLEEDING. Medical Clinics of North America 84:5, 1183-1208
CrossRef116
Lau, James Y.W., Sung, Joseph J.Y., Lee, Kenneth K.C., Yung, Man-yee, Wong, Simon K.H., Wu, Justin C.Y., Chan, Francis K.L., Ng, Enders K.W., You, Joyce H.S., Lee, C.W., Chan, Angus C.W., Chung, S.C. Sydney, . (2000) Effect of Intravenous Omeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcers. New England Journal of Medicine 343:5, 310-316
Full Text117
N.I. Church, K.R. Palmer. (2000) Injection therapy for endoscopic haemostasis. Best Practice & Research Clinical Gastroenterology 14:3, 427-441
CrossRef118
C. Rollhauser, D.E. Fleischer. (2000) Current status of endoscopic therapy for ulcer bleeding. Best Practice & Research Clinical Gastroenterology 14:3, 391-410
CrossRef119
Hamid Hussain, Seth Lapin, Mitchell S. Cappell. (2000) CLINICAL SCORING SYSTEMS FOR DETERMINING THE PROGNOSIS OF GASTROINTESTINAL BLEEDING. Gastroenterology Clinics of North America 29:2, 445-464
CrossRef120
James Y.W. Lau, S.C.Sydney Chung. (2000) Surgery in the acute management of bleeding peptic ulcer. Best Practice & Research Clinical Gastroenterology 14:3, 505-518
CrossRef121
Thomas J. Savides, Dennis M. Jensen. (2000) THERAPEUTIC ENDOSCOPY FOR NONVARICEAL GASTROINTESTINAL BLEEDING. Gastroenterology Clinics of North America 29:2, 465-487
CrossRef122
Gustavo A. Machicado, Dennis M. Jensen. (2000) Thermal probes alone or with epinephrine for the endoscopic haemostasis of ulcer haemorrhage. Best Practice & Research Clinical Gastroenterology 14:3, 443-458
CrossRef123
James J. Farrell, Lawrence S. Friedman. (2000) GASTROINTESTINAL BLEEDING IN OLDER PEOPLE. Gastroenterology Clinics of North America 29:1, 1-36
CrossRef124
Bruce E. Stabile, Michael J. Stamos. (2000) SURGICAL MANAGEMENT OF GASTROINTESTINAL BLEEDING. Gastroenterology Clinics of North America 29:1, 189-222
CrossRef125
Jean F Botha, Jake EJ Krige, Philippus C Bornman. (2000) Current perspectives in the management of non-variceal upper gastrointestinal bleeding. Digestive Endoscopy 12:1, 3-7
CrossRef126
Van Dam, Jacques, Brugge, William R., . (1999) Endoscopy of the Upper Gastrointestinal Tract. New England Journal of Medicine 341:23, 1738-1748
Full Text127
Nicholas I. Church, Kelvin R. Palmer. (1999) Diagnostic and therapeutic endoscopy. Current Opinion in Gastroenterology 15:6, 504
CrossRef128
J.A. Louw, I.N. Marks. (1999) The treatment of peptic ulcer disease. Current Opinion in Gastroenterology 15:6, 497
CrossRef129
(1999) Endoscopic Retreatment or Surgery for Severe Ulcer Rebleeding. New England Journal of Medicine 341:6, 455-456
Full Text130
B. Bour. (1999) Traitement endoscopique des hémorragies digestives hautes en dehors de l'HTP. Acta Endoscopica 29:S2, 343-350
CrossRef131
Jensen, Dennis M., . (1999) Management of Severe Ulcer Rebleeding. New England Journal of Medicine 340:10, 799-801
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