Mezawa Shinichi, Homma Hisato, Murase Kazuyuki, Doi Tadashi, Iyama Satoshi, Takada Kohichi, Hirata Kenichiro, Mezawa Fumie, Niitsu Yoshiro
Department of Gastroenterology, Tokeidai Hospital, 2-3 North-1 East-1, Chuo-ku, Sapporo 060-0031, Japan.
Hepatogastroenterology. 2003 May-Jun;50(51):735-7.
One of the most common complications related to endoscopic mucosal resection is hemorrhage; in almost every case, the bleeding is endoscopically managed, but some cases are unresponsive to the treatment. We have encountered three cases of endoscopically uncontrollable lower gastrointestinal hemorrhage after endoscopic mucosal resection in the colon which we successfully treated by urgent superselective transcatheter embolization. In our three cases, massive hemorrhage occurred immediately after endoscopic mucosal resection of a sessile polyp 25-40 mm in diameter, two cases in the ascending colon and one in the rectum. Although hemoclip placement was attempted in every case, hemostasis was not achieved. Emergency angiography disclosed massive extravasation of the contrast material in the colon. Hemostasis was achieved immediately after superselective transcatheter arterial embolizations with microcoils, with no observable ischemic complications and without the need of transfusions. In conclusion, superselective transcatheter embolization with microcoils should be considered a safe and efficient treatment option for endoscopically uncontrollable lower gastrointestinal hemorrhage occurring after endoscopic mucosal resection.
与内镜黏膜切除术相关的最常见并发症之一是出血；几乎在每例病例中，出血都可通过内镜进行处理，但有些病例对治疗无反应。我们遇到了3例结肠内镜黏膜切除术后内镜无法控制的下消化道出血病例，通过紧急超选择性经导管栓塞术成功治疗。在我们的3例病例中，直径25 - 40 mm的无蒂息肉内镜黏膜切除术后立即发生大量出血，2例发生在升结肠，1例在直肠。尽管每例均尝试放置止血夹，但未实现止血。急诊血管造影显示结肠内造影剂大量外渗。使用微线圈进行超选择性经导管动脉栓塞术后立即实现止血，无明显缺血并发症，也无需输血。总之，对于内镜黏膜切除术后发生的内镜无法控制的下消化道出血，微线圈超选择性经导管栓塞术应被视为一种安全有效的治疗选择。
