Current status and future challenges in the endoscopic management of non-variceal upper gastrointestinal bleeding in children

Purpose This study aimed to elucidate the characteristics of non-variceal upper gastrointestinal bleeding (NVUGIB) in children and the outcomes of endoscopic hemostasis (EH) performed by pediatric surgeons. Methods We retrospectively reviewed the medical records of pediatric patients with NVUGIB who...

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Bibliographic Details
Published in:Pediatric surgery international 2020-12, Vol.36 (12), p.1451-1458
Main Authors: Yabe, Kiyoaki, Kouchi, Katsunori, Takenouchi, Ayako, Matsuoka, Aki, Kudou, Wataru, Nakata, Chikako
Format: Article
Language:English
Subjects:
Adolescent
Endoscopy
Endoscopy, Digestive System - methods
Female
Gastrointestinal Hemorrhage - therapy
Hemostasis, Endoscopic - methods
Humans
Male
Medicine
Medicine & Public Health
Original Article
Patients
Pediatric Surgery
Pediatrics
Retrospective Studies
Surgery
Treatment Outcome
Ulcers
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Summary:Purpose This study aimed to elucidate the characteristics of non-variceal upper gastrointestinal bleeding (NVUGIB) in children and the outcomes of endoscopic hemostasis (EH) performed by pediatric surgeons. Methods We retrospectively reviewed the medical records of pediatric patients with NVUGIB who had undergone esophagogastroduodenoscopy (EGD) at our hospital, between December 2006 and March 2020. Results Thirty-six patients were included. The most common endoscopic diagnosis was gastritis (28%), followed by gastric ulcer (25%) and duodenal ulcer (25%). Thirty patients (83%) had underlying diseases, including a recent viral infection (39%), followed by Helicobacter pylori infection (14%). Fourteen patients (39%) underwent EH, exhibiting a high initial rate of hemostasis (100%). This was achieved in 12/14 patients by clipping. One patient was treated using a combination of a hypersaline and epinephrine (HSE) injection and coagulation therapy, as the ulcer exceeded the width of the hemoclips. Rebleeding occurred in one patient (7.1%) initially treated with pure ethanol injections. The partial view of the pediatric duodenum prevented the placement of hemoclips; hence, the patient was treated using a combination of HSE and coagulation therapy. Conclusion Clipping, injection, and/or coagulation therapy can lead to high success rates for hemostasis, considering the anatomical characteristics in a pediatric population.
ISSN:0179-0358
1437-9813
DOI:10.1007/s00383-020-04755-4