The use of endoclips in the treatment of nonvariceal gastrointestinal bleeding. Surg Laparosc Endosc Percutan Tech. 2009;19:2-10. [PMID: 19238058 DOI: 10.1097/SLE.0b013e31818e9297]

Three Year Old Male with Multiple Dieulafoy Lesions Treated with Epinephrine Injections via Therapeutic Endoscopy

Dieulafoy lesions, vascular anomalies typically found along the gastrointestinal tract, have been viewed as rare and obscure causes of sudden intestinal bleeding, especially in pediatric patients. Since their discovery in the late 19th century, the reported incidence has increased. This is due to an increased awareness of, and knowledge about, their presentation and to advanced endoscopic diagnosis and therapy. Our patient was a three-year-old male, without a complex medical history. He presented to the emergency department with acute hematemesis with blood clots and acute anemia requiring blood transfusion. Endoscopy revealed four isolated Dieulafoy lesions along the lesser curvature of the stomach, which were treated with an epinephrine injection. The Dieulafoy lesion, although thought to be rare, should be considered when investigating an acute gastrointestinal bleed. These lesions have been successfully treated endoscopically. Appropriate anticipation and preparation for diagnosis and therapy can lead to optimal outcomes for the pediatric patient.

Covered self-expanding metal stents for the treatment of refractory esophageal nonvariceal bleeding: a case series

INTRODUCTION

This study aimed to assess the safety and effectiveness of covered self-expanding metal stents for the treatment of nonvariceal esophageal bleeding in patients for whom routine therapies have failed.

PATIENTS AND METHODS

A retrospective analysis was conducted on patients with esophageal bleeding in our hospital. Data on hemostatic effects and complications were collected from patients who underwent esophageal stenting.

RESULTS

In total, 4 patients were treated with five stents. In all 4 patients, the placement of esophageal stents immediately stopped the ongoing bleeding. One patient experienced recurrent bleeding 4 days after the removal of the first stent. Hemostasis was achieved after the insertion of a second stent. No stent-related complications occurred during or after stent implantation in the other 3 patients.

CONCLUSIONS

The implantation of a covered self-expandable metal stent is a safe and effective alternative to treat acute, nonvariceal esophageal bleeding after routine therapies have failed.

Postpolypectomy bleeding: incidence, risk factors, prevention, and management

Endoscopic polypectomy is at the forefront of colorectal cancer (CRC) prevention. However, endoscopic polypectomy is not completely free of complications, with bleeding being one of the most common complications encountered. In view of the ongoing campaign to introduce colorectal cancer screening to the population, addressing the issue of colonoscopic complications, and postpolypectomy bleeding (PPB) in particular is becoming more important. Despite the fact that the overall incidence of PPB is low, predisposing factors need to be elucidated to further decrease the frequency of this complication. Furthermore, the role of various techniques of PPB prophylaxis remains controversial. We review recent studies on the incidence, risk factors, prophylaxis, and management of PPB.

Prevention and treatment of gastrointestinal bleeding after therapeutic endoscopy for alimentary tract disease

AIM: To analyze the prevention and treatment of gastrointestinal bleeding after therapeutic endoscopy for alimentary tract disease.

METHODS: The clinical data for 42 patients who received endoscopic treatment for acute hemorrhage after endoscopic therapy were retrospectively analyzed.

RESULTS: Of 1 089 patients undergoing therapeutic endoscopy, 392 underwent argon plasma coagulation (APC), of them 3 (0.8%) had gastrointestinal bleeding; 36 underwent loop ligature, of them 4 (11.1%) had bleeding; 64 underwent endoscopic mucosal resection (EMR), of them 8 (12.5%) had bleeding; 367 underwent high frequency electric coagulation, of them 17 (4.6%) had bleeding; 230 underwent ERCP-EST, of them 10 (4.4%) had bleeding. The total incidence of iatrogenic bleeding was 3.9% (42/1 089). The majority of patients developing bleeding were managed successfully by APC or titanium clipping during endoscopic procedures, whereas 4 patients developed uncontrolled bleeding and turned to surgical intervention. One patient developed bleeding after loop ligature and died of multiple organ dysfunction syndrome and diaphragmatic paralysis after vascular interventional therapy.

CONCLUSION: Gastrointestinal bleeding after minimally invasive endoscopic surgery is preventable and controllable. Effective therapeutic measures for hemorrhage within 48 hours can decrease blood loss, blood transfusion and drug consumption, and increase the rate of cost/effectiveness. Preventive usage of metal clip can significantly decrease the incidence of post-operative bleeding after therapeutic endoscopy.