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Endoscopic clipping in the lower gastrointestinal tract

World Journal of Gastrointestinal Endoscopy 2009年第1期1卷 7-11页

作者： Akira Hokama Kazuto Kishimoto Fukunori Kinjo Jiro Fujita Department of Medicine and Therapeutics(First Department of Internal Medicine) Control and Prevention of Infectious DiseasesFaculty of MedicineUniversity of the RyukyusOkinawa 903-0125Japan Department of Endoscopy Ryukyus University HospitalOkinawa 903-0125Japan

Endoscopic clipping has been established as a safe and effective method for the treatment of nonvariceal upper gastrointestinal bleeding in numerous randomized studies.Recently,clipping has been applied to various lesions in the lower gastrointestinal tract,including diverticular bleeding,postpolypectomy bleeding,and repair of perforations with successful outcomes.We review the safety and efficacy of this maneuver for the management of diseases in the lower gastrointestinal tract.

关键词： hemoclip Clipping Clips Hemostasis Gastrointestinal bleeding Endoscopy Diverticular disease Postpolypectomy bleeding Acute hemorrhagic rectal ulcer Colon

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Mallory-Weiss tear during gastric endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2011年第7期3卷 151-153页

作者： Hiroki Hongou Kuangi Fu Hiroya Ueyama Taiji Takahashi Tsutomu Takeda Akihisa Miyazaki Sumio Watanabe Department of Gastroenterology Juntendo University Nerima Hospital Nerima Tokyo 177-0033 Japan Department of Gastroenterology Juntendo University School of Medicine Tokyo 113-8431 Japan

A 78-year-old woman was referred to our department for treatment of an early gastric cancer. Esophagogastroduodenoscopy (EGD) demonstrated a flat elevated lesion and a polypoid lesion on the greater curvature of the antrum. Histological analysis of, endoscopic biopsy samples taken from these lesions revealed an adenocarcinoma and a hyperplastic polyp, respectively. ESD was conducted for removal of the lesions. Carbon dioxide (CO2) in- stead of room air was used for insufflation, and the patient was adequately sedated without struggling or vomiting during the treatment. No significant bleeding from the lesion was observed during ESD, but fresh blood was identified endoscopically. Surprisingly, a Mallory- Weiss tear with active bleeding was detected on the lesser curvature of the gastric corpus. A total of eight hemoclips were applied for hemostasis. Both lesions were completely removed en bloc, and no bleeding or perforation developed after ESD. Histologically, the first lesion was apapillary carcinoma limited to the mucosal layer and without lymphovascular invasion or involvement of the surgical margins, while the second lesion was a benign hyperplastic polyp.

关键词： Mallory-Weiss tear Endoscopic submucosal dissection Early gastric cancer Hemostasis hemoclip

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