| Theme |
Diseases of alimentary tract in maintenance dialysis patients -- tendency and management from a view point of symptomatology |
| Title |
Avoiding gastrointestinal bleeding during endoscopic and surgical procedures |
| Author |
Hiromi Hamada |
Department of Surgery, Nikko Memorial Hospital |
| Author |
Jouji Takada |
Department of Surgery, Nikko Memorial Hospital |
| Author |
Kazunori Yokoyama |
Department of Gastroenterology, Nikko Memorial Hospital |
| [ Summary ] |
There is an increased risk of death associated with gastrointestinal bleeding in dialysis patients. Those patients are at a high risk of having acute gastric mucosal lesions and gastric ulcers in the upper gastrointestinal tract, as well as constipation due to overuse of phosphate binders. This can lead to rectal ulcers. The determination of whether to give priority to upper or lower tract endoscopy is important. It should be based on symptoms used to estimate of the bleeding site. In those cases in which the endoscope can be used for treatment, the correct hemostatic method can be selected in relation to the lesion. At the time of surgery, the proper surgical procedure must be selected in relation to risk. For dialysis after hemostasis, anticoagulants with a short half-life are recommended. To improve outcomes, the selection of dialysis method should be made while considering hemodynamics and electrolyte abnormalities. Close cooperation between endoscopists, surgeons and dialysis physicians is also necessary. |