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Endoscopic treatment and follow-up of gastrointestinal Dieulafoy's lesions

World Journal of Gastroenterology 2005年第38期11卷 6022-6026页

作者： Panagiotis Katsinelos george Paroutoglou Kostas Mimidis Athanasios Beltsis Basilios Papaziogas george gelas Yiannis Kountouras Department of Endoscopy and Motility Unit 2nd Surgical Clinic 2nd Department of Internal Medicine

AIM: To investigate retrospectively the clinical and endoscopic features of bleeding Dieulafoy's lesions and to assess the short- and long-term effectiveness of endoscopic ***: Twenty-three patients who had gastrointestinal bleeding from Dieulafoy's lesions underwent endoscopic therapy. Demographic data, mode of presentation, riskfactors for gastrointestinal bleeding, blood transfusion requirements, endoscopic findings, details of endoscopic therapy, recurrence of bleeding, and mortality rates were collected and analyzed ***: Hemostasis was attempted by dextrose 50% plus epinephrine in 10 patients, hemoclipping in 8 patients,heater probe in 2 patients and ethanolamine oleate in 2 patients. Comorbid conditions were present in 17 patients (74%). Overall permanent hemostasis was achieved in 18 patients (78%). Initial hemostasis was successful with no recurrent bleeding in patients treated with hemoclipping, heater probe or ethanolamine injection. In the group of patients who received dextrose 50% plus epinephrine injection treatment, four (40%) had recurrent bleeding and one (10%) had unsuccessful initial *** the four patients who had rebleeding, three had unsuccessful hemostasis with similar treatment. Surgical treatment was required in five patients (22%) owing to uncontrolled bleeding, recurrent bleeding with unsuccessful retreatment and inability to approach the lesion. One patient (4.3%) died of sepsis after operation during hospitalization. There were no side-effects related to endoscopic therapy. None of the patients in whom permanent hemostasis was achieved presented with rebleeding from Dieulafoy's lesion over a mean long-term follow-up of 29.8 ***: Bleeding from Dieulafoy's lesions can be managed successfully by endoscopic methods, which should be regarded as the first choice. Endoscopic hemoclipping therapy is recommended for bleeding Dieulafoy's lesions.

关键词： Endoscopic treatment Dieulafoy lesion Gastrointestinal tract

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Partially covered vs uncovered sphincterotome and postendoscopic sphincterotomy bleeding

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World Journal of Gastroenterology 2010年第40期16卷 5077-5083页

作者： Panagiotis Katsinelos george Paroutoglou Jannis Kountouras Grigoris Chatzimavroudis Christos Zavos Sotiris Terzoudis Taxiarchis Katsinelos Kostas Fasoulas george gelas george Tzovaras Ioannis Pilpilidis Department of Endoscopy and Motility Unit Medical School Aristotle University of Thessaloniki G. Gennimatas General Hospital Department of Gastroenterology University Hospital of Thessaly 2nd Department of Internal Medicine Medical School Aristotle University of Thessaloniki Ippokration Hospital

AIM: To prospectively compare partially covered vs uncovered sphincterotome use on post-endoscopic biliary sphincterotomy (ES) hemorrhage and other complications. METHODS: All patients referred for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) were randomly assigned to undergo ES either with a partially covered or an uncovered sphincterotome. Both patient and technical risk factors contributing to the development of post-ES bleeding were recorded and analyzed. The characteristics of bleeding was recorded during and after ES. Other complications were also compared. RESULTS: Three-hundred and eighty-seven patients were recruited in this study; 194 patients underwent ES with a partially covered sphincterotome and 193 with conventional uncovered sphincterotome. No statistical difference was noted in the baseline characteristics and risk factors for post-ES induced hemorrhage between the 2 groups. No significant difference in the incidence and pattern of visible bleeding rates was found between the 2 groups (immediate bleeding in 24 patients with the partially covered sphincterotome vs 19 patients with the uncovered sphincterotome, P = 0.418). Delayed bleeding was observed in 2 patients with a partially covered sphincterotome and in 1 patient with an uncovered sphincterotome (P = 0.62). No statistical difference was noted in the rate of other complications. CONCLUSION: The partially covered sphincterotome was not associated with a lower frequency of bleeding. Also, there was no difference in the incidence of other significant complications between the 2 types of sphincterotome.

关键词： Sphincterotome Endoscopic sphincterotomy Hemorrhage Complications

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