非静脉曲张性上消化道出血的内镜治疗新进展
New Endoscopic Treatment Techniques for Non-Variceal Upper Gastrointestinal Bleeding
DOI: 10.12677/jcpm.2025.43386, PDF,   
作者: 赵馨宇：济宁医学院临床医学院(附属医院)，山东 济宁；景德怀：济宁医学院附属医院消化内科，山东 济宁
关键词: 非静脉曲张性上消化道出血；内镜下治疗；局部止血剂；Non-Variceal Upper Gastrointestinal Bleeding； Endoscopic Treatment； Local Hemostatic
摘要: 随着内镜技术的发展，非静脉曲张性上消化道出血的止血疗效得到显著提高。目前内镜下止血技术主要包括机械止血、热凝止血、注射止血和局部止血剂止血等，各类止血技术的选用标准受多种因素的影响，目前尚无金标准。本文综述了非静脉曲张性上消化道出血内镜止血的新技术，并就原有技术应用范围和联合应用的发展进行论述。
Abstract: With the development of endoscopic technology, the hemostatic efficacy of non-variceal upper gastrointestinal bleeding has been significantly improved. Currently, endoscopic hemostatic techniques mainly include mechanical hemostasis, thermal coagulation hemostasis, injection therapy, and local hemostatic agents. The selection standards of various hemostasis techniques are influenced by various factors, and there is currently no gold standard. This article reviews and introduces new technologies for endoscopic hemostasis, and discusses the application scope of existing technologies and the development of combined applications.
文章引用：赵馨宇, 景德怀. 非静脉曲张性上消化道出血的内镜治疗新进展[J]. 临床个性化医学, 2025, 4(3): 606-613. https://doi.org/10.12677/jcpm.2025.43386

参考文献

[1] Gunjan, D., Sharma, V., Rana, S.S. and Bhasin, D.K. (2014) Small Bowel Bleeding: A Comprehensive Review. Gastroenterology Report, 2, 262-275. [Google Scholar] [CrossRef] [PubMed]
[2] Gralnek, I.M., Neeman, Z. and Strate, L.L. (2017) Acute Lower Gastrointestinal Bleeding. New England Journal of Medicine, 376, 1054-1063. [Google Scholar] [CrossRef] [PubMed]
[3] Boonpongmanee, S., Fleischer, D.E., Pezzullo, J.C., Collier, K., Mayoral, W., Al-Kawas, F., et al. (2004) The Frequency of Peptic Ulcer as a Cause of Upper-Gi Bleeding Is Exaggerated. Gastrointestinal Endoscopy, 59, 788-794. [Google Scholar] [CrossRef] [PubMed]
[4] Enestvedt, B.K., Gralnek, I.M., Mattek, N., Lieberman, D.A. and Eisen, G. (2008) An Evaluation of Endoscopic Indications and Findings Related to Nonvariceal Upper-Gi Hemorrhage in a Large Multicenter Consortium. Gastrointestinal Endoscopy, 67, 422-429. [Google Scholar] [CrossRef] [PubMed]
[5] Loperfido, S., Baldo, V., Piovesana, E., Bellina, L., Rossi, K., Groppo, M., et al. (2009) Changing Trends in Acute Upper-Gi Bleeding: A Population-Based Study. Gastrointestinal Endoscopy, 70, 212-224. [Google Scholar] [CrossRef] [PubMed]
[6] Wuerth, B.A. and Rockey, D.C. (2017) Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis. Digestive Diseases and Sciences, 63, 1286-1293. [Google Scholar] [CrossRef] [PubMed]
[7] 陈浩源, 金世柱, 张思佳. 内镜技术治疗下消化道出血的研究进展[J]. 现代消化及介入诊疗, 2021, 26(6): 786-788.
[8] Novak, I. and Bass, L.M. (2023) Gastrointestinal Bleeding in Children. Gastrointestinal Endoscopy Clinics of North America, 33, 401-421. [Google Scholar] [CrossRef] [PubMed]
[9] Pai, A.K. and Fox, V.L. (2017) Gastrointestinal Bleeding and Management. Pediatric Clinics of North America, 64, 543-561. [Google Scholar] [CrossRef] [PubMed]
[10] 鲁健. 内镜下金属钛夹与热凝止血治疗非静脉曲张上消化道出血的效果比较[J]. 当代医学, 2022, 28(10): 122-124.
[11] 李月. 胃镜下尼龙绳套扎和金属止血夹联合治疗消化性溃疡出血的效果探讨[J]. 中国医疗器械信息, 2022, 28(9): 104-106.
[12] 刘佳, 丁建民, 祝丽娟. 内镜下Olympus金属钛夹与和谐夹对消化性溃疡活动性出血的效果比较[J]. 临床研究, 2023, 31(11): 67-69.
[13] 陈泽庭, 林昱, 陈朝武. 消化内镜下和谐夹与金属钛夹止血治疗上消化道出血患者的效果比较[J]. 中国民康医学, 2023, 35(7): 153-155.
[14] Schmidt, A., Gölder, S., Goetz, M., Meining, A., Lau, J., von Delius, S., et al. (2018) Over-the-Scope Clips Are More Effective than Standard Endoscopic Therapy for Patients with Recurrent Bleeding of Peptic Ulcers. Gastroenterology, 155, 674-686. [Google Scholar] [CrossRef] [PubMed]
[15] Laine, L., Barkun, A.N., Saltzman, J.R., Martel, M. and Leontiadis, G.I. (2021) ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. American Journal of Gastroenterology, 116, 899-917. [Google Scholar] [CrossRef] [PubMed]
[16] Tanaka, S., Toyonaga, T., Morita, Y., Ishida, T., Hoshi, N., Grimes, K.L., et al. (2017) Efficacy of a New Hemostatic Forceps during Gastric Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial. Journal of Gastroenterology and Hepatology, 32, 846-851. [Google Scholar] [CrossRef] [PubMed]
[17] 陈礼娟, 林浩, 姜平, 等. 经内镜皮圈套扎治疗急性非静脉曲张性上消化道出血的应用价值[J]. 系统医学, 2023, 8(6): 24-27.
[18] Takizawa, K., Oda, I., Gotoda, T., Yokoi, C., Matsuda, T., Saito, Y., et al. (2008) Routine Coagulation of Visible Vessels May Prevent Delayed Bleeding after Endoscopic Submucosal Dissection—An Analysis of Risk Factors. Endoscopy, 40, 179-183. [Google Scholar] [CrossRef] [PubMed]
[19] Toka, B., Eminler, A.T., Karacaer, C., Uslan, M.I., Koksal, A.S. and Parlak, E. (2019) Comparison of Monopolar Hemostatic Forceps with Soft Coagulation versus Hemoclip for Peptic Ulcer Bleeding: A Randomized Trial (with Video). Gastrointestinal Endoscopy, 89, 792-802. [Google Scholar] [CrossRef] [PubMed]
[20] Soetikno, R., Ishii, N., Kolb, J.M., Hammad, H. and Kaltenbach, T. (2018) The Role of Endoscopic Hemostasis Therapy in Acute Lower Gastrointestinal Hemorrhage. Gastrointestinal Endoscopy Clinics of North America, 28, 391-408. [Google Scholar] [CrossRef] [PubMed]
[21] Yeh, P., Le, P., Chen, C., Chao, H. and Lai, M. (2022) Application of Argon Plasma Coagulation for Gastrointestinal Angiodysplasia in Children—Experience from a Tertiary Center. Frontiers in Pediatrics, 10, Article 867632. [Google Scholar] [CrossRef] [PubMed]
[22] Alali, A.A. and Barkun, A.N. (2022) An Update on the Management of Non-Variceal Upper Gastrointestinal Bleeding. Gastroenterology Report, 11, goad011. [Google Scholar] [CrossRef] [PubMed]
[23] Kay, M., Bhesania, N. and Wyllie, R. (2021) Esophagogastroduodenoscopy and Related Techniques. In: Pediatric Gastrointestinal and Liver Disease, Elsevier, 613-638. [Google Scholar] [CrossRef] 
[24] Chen, Y., Barkun, A.N., Soulellis, C., Mayrand, S. and Ghali, P. (2012) Use of the Endoscopically Applied Hemostatic Powder TC-325 in Cancer-Related Upper GI Hemorrhage: Preliminary Experience (with Video). Gastrointestinal Endoscopy, 75, 1278-1281. [Google Scholar] [CrossRef] [PubMed]
[25] Bustamante-Balén, M. and Plumé, G. (2014) Role of Hemostatic Powders in the Endoscopic Management of Gastrointestinal Bleeding. World Journal of Gastrointestinal Pathophysiology, 5, 284-292. [Google Scholar] [CrossRef] [PubMed]
[26] de Nucci, G., Reati, R., Arena, I., Bezzio, C., Devani, M., Corte, C.D., et al. (2020) Efficacy of a Novel Self-Assembling Peptide Hemostatic Gel as Rescue Therapy for Refractory Acute Gastrointestinal Bleeding. Endoscopy, 52, 773-779. [Google Scholar] [CrossRef] [PubMed]
[27] Song, H., Zhang, L. and Zhao, X. (2009) Hemostatic Efficacy of Biological Self-Assembling Peptide Nanofibers in a Rat Kidney Model. Macromolecular Bioscience, 10, 33-39. [Google Scholar] [CrossRef] [PubMed]
[28] Luo, Z., Wang, S. and Zhang, S. (2011) Fabrication of Self-Assembling D-Form Peptide Nanofiber Scaffold D-Eak16 for Rapid Hemostasis. Biomaterials, 32, 2013-2020. [Google Scholar] [CrossRef] [PubMed]
[29] Paoluzi, O.A., Troncone, E., De Cristofaro, E., Sibilia, M., Monteleone, G. and Del Vecchio Blanco, G. (2023) Hemostatic Powders in Non-Variceal Upper Gastrointestinal Bleeding: The Open Questions. Medicina, 59, Article 143. [Google Scholar] [CrossRef] [PubMed]
[30] Barkun, A. (2013) New Topical Hemostatic Powders in Endoscopy. Gastroenterology & Hepatology, 9, 744-746.
[31] Alali, A.A., Moosavi, S., Martel, M., Almadi, M. and Barkun, A.N. (2022) Topical Hemostatic Agents in the Management of Upper Gastrointestinal Bleeding: A Meta-Analysis. Endoscopy International Open, 11, E368-E385. [Google Scholar] [CrossRef] [PubMed]
[32] Sung, J.J.Y., Moreea, S., Dhaliwal, H., Moffatt, D.C., Ragunath, K., Ponich, T., et al. (2022) Use of Topical Mineral Powder as Monotherapy for Treatment of Active Peptic Ulcer Bleeding. Gastrointestinal Endoscopy, 96, 28-35. [Google Scholar] [CrossRef] [PubMed]
[33] Lau, J.Y.W., Pittayanon, R., Kwek, A., Tang, R.S., Chan, H., Rerknimitr, R., et al. (2022) Comparison of a Hemostatic Powder and Standard Treatment in the Control of Active Bleeding from Upper Nonvariceal Lesions. Annals of Internal Medicine, 175, 171-178. [Google Scholar] [CrossRef] [PubMed]
[34] Akhtar, K., Byrne, J.P., Bancewicz, J. and Attwood, S.E.A. (2000) Argon Beam Plasma Coagulation in the Management of Cancers of the Esophagus and Stomach. Surgical Endoscopy, 14, 1127-1130. [Google Scholar] [CrossRef] [PubMed]
[35] Ofosu, A. (2019) Endoscopic Management of Bleeding Gastrointestinal Tumors. Annals of Gastroenterology, 32, 346-351. [Google Scholar] [CrossRef] [PubMed]
[36] Karna, R., Deliwala, S., Ramgopal, B., Mohan, B.P., Kassab, L., Becq, A., et al. (2023) Efficacy of Topical Hemostatic Agents in Malignancy-Related GI Bleeding: A Systematic Review and Meta-Analysis. Gastrointestinal Endoscopy, 97, 202-208. [Google Scholar] [CrossRef] [PubMed]
[37] 黄鹏. 胃镜下肾上腺素注射结合钛夹治疗溃疡性上消化道出血患者的疗效观察[J]. 中国现代药物应用, 2023, 17(3): 120-122.
[38] 蒋蕾. 胃镜下注射肾上腺素与钛夹联合治疗急性非静脉曲张性上消化道出血的效果研究[J]. 中国现代药物应用, 2023, 17(14): 123-125.
[39] 韩敏, 张顺利. 内镜金属止血夹联合硬化剂注射治疗95例溃疡性上消化道出血患者的临床效果观察[J]. 首都食品与医药, 2023, 30(22): 21-24.
[40] Tringali, A., Thomson, M., Dumonceau, J., Tavares, M., Tabbers, M., Furlano, R., et al. (2016) Pediatric Gastrointestinal Endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive Summary. Endoscopy, 49, 83-91. [Google Scholar] [CrossRef] [PubMed]
[41] Liu, K., Gao, L., Bai, J.W., Wang, L.L., Zhu, S.H., Zhao, X., et al. (2023) Efficacy of New Hemostatic Techniques in Nonvariceal Gastrointestinal Bleeding: A Systematic Review and Network Meta-Analysis. Journal of Digestive Diseases, 24, 181-193. [Google Scholar] [CrossRef] [PubMed]
[42] Wasserman, R.D., Abel, W., Monkemuller, K., Yeaton, P., Kesar, V. and Kesar, V. (2025) Non-Variceal Upper Gastrointestinal Bleeding and Its Endoscopic Management. Turkish Journal of Gastroenterology, 35, 599-608. [Google Scholar] [CrossRef] [PubMed]
[43] Chapelle, N., Martel, M., Bardou, M., Almadi, M. and Barkun, A.N. (2022) Role of the Endoscopic Doppler Probe in nonvariceal Upper Gastrointestinal Bleeding: Systematic Review and Meta-Analysis. Digestive Endoscopy, 35, 4-18. [Google Scholar] [CrossRef] [PubMed]