護理之家老人因上消化道出血內視鏡檢查的適用性：經口與經鼻之比較

Feasibility of Endoscopic Examination of Upper Gastrointestinal Bleeding for Aged Residents in Nursing Homes: Comparison of Trans-oral and Trans-nasal Routes

洪弘昌(Hung-Hung Chang) ； 林榆玲(Yu-Ling Lin) ； 黃依欣(I-Shin Huang) ； 詹德欽(Der-Chin Jan) ； 莊家銘(Chia-Ming Chuang) ； 呂源三(Yuan-San Lu)

《台灣老年醫學雜誌》 1卷4期 (2006/05) Pp. 240-246

摘要

Objectives: Hemorrhage in the upper gastrointestinal (GI) tract is one of the most common causes of hospitalization for long-term care facility residents. Upper GI endoscopy, while generally regarded as an effective procedure for evaluation and treatment of upper GI bleeding, tends to cause fear and reluctance of cooperation in elderly patients. We accordingly designed this study to investigate different methods of esophageal insertion influencing the successful rate of upper GI endoscopy.
Methods: We conducted a prospective study on long-term care facility residents diagnosed with upper gastrointestinal bleeding and admitted to a hospital in Nantou County from January to December 2005. One hundred and eighty patients with the certain diagnosis were consecutively enrolled and divided randomly and equally into 2 groups. Patients in Group A received the upper GI endoscopy via mouth (9 mm in diameter). Patients in Group B received the upper GI endoscopy via nasal route (ultra-slim 5.9 mm in diameter). Successful performance was defined as a complete examination of upper GI endoscopy within 15 minutes from the patient's entry into the endoscopic room. Upper GI endoscopy was performed by the same experienced endoscopist and two nurses. Helicobacter pylori (Hp) infection was also checked with biopsy specimen by CLO test. All patients were provided a written informed consent before participating in this study.
Results: Successful rates between the two groups (A vs. B=77.7% vs. 95.5%, p＜0.05) showed a significant difference. Naso-gastric tube insertion and related esophageal diseases (ulcers and esophagitis) were the most common causes for upper GI bleeding in elderly patients.
Conclusion: Compared with the traditional endoscopy via oral route, the newly-developed ultra-slim upper GI endoscope through nasal route could produce a higher successful rate of performance and decreases the time Consnmption. However, incomplete apparatus package of ultra-slim upper GI endoscope i.e., endoscopic variceal ligator and heater probes for thermo-coagulation, may limit the further therapeutic application in severe cases.

關鍵字

老年人 ； 上消化道出血 ； 經鼻／經口上消化道內視鏡

並列摘要

Objectives: Hemorrhage in the upper gastrointestinal (GI) tract is one of the most common causes of hospitalization for long-term care facility residents. Upper GI endoscopy, while generally regarded as an effective procedure for evaluation and treatment of upper GI bleeding, tends to cause fear and reluctance of cooperation in elderly patients. We accordingly designed this study to investigate different methods of esophageal insertion influencing the successful rate of upper GI endoscopy.
Methods: We conducted a prospective study on long-term care facility residents diagnosed with upper gastrointestinal bleeding and admitted to a hospital in Nantou County from January to December 2005. One hundred and eighty patients with the certain diagnosis were consecutively enrolled and divided randomly and equally into 2 groups. Patients in Group A received the upper GI endoscopy via mouth (9 mm in diameter). Patients in Group B received the upper GI endoscopy via nasal route (ultra-slim 5.9 mm in diameter). Successful performance was defined as a complete examination of upper GI endoscopy within 15 minutes from the patient's entry into the endoscopic room. Upper GI endoscopy was performed by the same experienced endoscopist and two nurses. Helicobacter pylori (Hp) infection was also checked with biopsy specimen by CLO test. All patients were provided a written informed consent before participating in this study.
Results: Successful rates between the two groups (A vs. B=77.7% vs. 95.5%, p＜0.05) showed a significant difference. Naso-gastric tube insertion and related esophageal diseases (ulcers and esophagitis) were the most common causes for upper GI bleeding in elderly patients.
Conclusion: Compared with the traditional endoscopy via oral route, the newly-developed ultra-slim upper GI endoscope through nasal route could produce a higher successful rate of performance and decreases the time Consnmption. However, incomplete apparatus package of ultra-slim upper GI endoscope i.e., endoscopic variceal ligator and heater probes for thermo-coagulation, may limit the further therapeutic application in severe cases.

並列關鍵字

elderly patients ； upper GI bleeding ； via nasal route & via mouth upper GI endoscope