[Endoscopic Doppler sonography]

Proctoscopic Doppler ultrasound in diagnostics and treatment of bleeding hemorrhoids

PURPOSE

Endoscopic Doppler sonography is a relatively new technique in the diagnostics of intestinal hemorrhage. It has been used mainly for bleeding gastroduodenal ulcers, but can also be utilized in the lower digestive tract.

METHODS

In the study presented 80 patients with symptomatic hemorrhoids of first degree and previous hemorrhage were randomized in two groups. The 40 patients in Group A were examined by transproctoscopic Doppler ultrasound. After measuring the vessels depth, local injection treatment with 5 percent phenol almond oil followed. The patients in Group B had been given conventional sclerotherapy without the aid of Doppler investigation. The success of treatment was checked using Doppler sonographics six weeks later and the results were statistically compared.

RESULTS

In the patients in Group A, the hemorrhoids proved to be totally eliminated in 93 percent vs. 38 percent of the patients in Group B (P, 0.1 percent).

CONCLUSIONS

Proctoscopic Doppler ultrasound is useful in the evaluation and sclerotherapy of symptomatic first-degree hemorrhoids.

Doppler sonographic diagnostics and treatment control of symptomatic first-degree hemorrhoids. Preliminary report and results

Endoscopic Doppler sonography is a relatively new technique in the diagnostics of intestinal hemorrhage. It has been used mainly for gastroduodenal ulcer bleeding, but is also utilized in the lower digestive tract. For the first time, the effectiveness of Doppler ultrasound was studied in hemorrhoidal disease. In the trial presented, 60 patients with symptomatic first-degree hemorrhoids and previous bleeding were randomized in two groups. Thirty patients of group A were examined by transproctoscopic Doppler sonography. After measuring the vessel's depth, local sclerosing treatment with 6 ml of 5% phenol almond oil was carried out. In the 30 patients of group B, the same amount of the solution was injected without the aid of Doppler investigation. The success of treatment was checked Doppler sonographically six weeks later and the results were compared statistically. In the patients of the Doppler group, the hemorrhoids proved to be totally eliminated in 87% versus only 37% in the patients of the non-Doppler group (P < 0.1). Proctoscopic Doppler ultrasound is useful in the evaluation and sclerotherapy of bleeding hemorrhoids.

Dieulafoy's disease controlled by Doppler ultrasound endoscopic treatment

Dieulafoy's disease is a gastric vascular malformation, that presents clinically as acute upper intestinal haemorrhage. Emergency endoscopy is the most effective method of diagnosing the disease. Until recently surgical resection was the most usual treatment. A case is reported of Dieulafoy's lesion with haemodynamically relevant bleeding. Successful endoscopic treatment was performed with the aid of Doppler ultrasound. A follow up of 11 months with no haemorrhaging was recorded.

Doppler-controlled injection treatment of Dieulafoy's disease

Dieulafoy's anomaly is a vascular malformation of the upper stomach, which typically causes massive and recurrent haemorrhage. Emergency endoscopy is the most effective method of diagnosing the disease. Until recently, the therapy of choice was surgical resection. Five patients with spontaneously stopped bleeding from Dieulafoy's ulceration were investigated. Transendoscopic Doppler ultrasound was used to identify arterial blood flow from the lesions. Local injection treatment was performed. Successful therapy resulted in the disappearance of arterial pulsations and no rebleeding occurred. The endoscopic Doppler is of diagnostic value in the evaluation of Dieulafoy's ulcer and enables control of endoscopic sclerotherapy.