Prakash C, Chokshi H, Walden D T, Aliperti G
Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Endoscopy. 1999 Aug;31(6):460-3. doi: 10.1055/s-1999-124.
Early reports of urgent colonoscopy in acute lower intestinal bleeding suggest a role for endoscopic therapy for bleeding colonic lesions, but scant data exist on bleeding diverticula. We report our experience with endoscopic hemostasis in acute diverticular bleeding.
Bleeding diverticula were identified on urgent diagnostic endoscopy in five patients with acute gastrointestinal bleeding, two in the duodenum, and three in the colon. All patients had co-morbid conditions preventing more conventional therapeutic approaches. The five cases are described, including the technique of endoscopic hemostasis and outcome.
Endoscopic therapy using epinephrine injection, thermal cautery and/or laser therapy successfully induced hemostasis in all patients. One patient died of co-morbid illness during the hospital stay, while the remaining four patients had no recurrent bleeding over a mean follow-up period of 20.6 months.
Endoscopic therapy of bleeding diverticula is technically possible when the culprit diverticulum can be identified. This therapeutic modality may have a place in debilitated patients in whom other more invasive procedures are contraindicated, but further experience is needed to establish its safety.
早期关于急性下消化道出血时紧急结肠镜检查的报道提示内镜治疗对结肠出血性病变有作用，但关于憩室出血的数据很少。我们报告我们在急性憩室出血内镜止血方面的经验。
在5例急性胃肠道出血患者的紧急诊断性内镜检查中发现出血性憩室，其中2例在十二指肠，3例在结肠。所有患者均有合并症，妨碍采用更传统的治疗方法。描述了这5例病例，包括内镜止血技术及结果。
使用肾上腺素注射、热烧灼和/或激光治疗的内镜治疗成功使所有患者止血。1例患者在住院期间死于合并症，其余4例患者在平均20.6个月的随访期内无再出血。
当能确定出血憩室时，内镜治疗出血性憩室在技术上是可行的。这种治疗方式在其他更具侵入性的手术禁忌的虚弱患者中可能有一席之地，但需要更多经验来确定其安全性。
