Katsinelos Panagiotis, Kountouras Jannis, Chatzimavroudis Grigoris, Zavos Christos, Fasoulas Kostas, Katsinelos Taxiarchis, Pilpilidis Ioannis, Paroutoglou George
Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Thessaloniki, Greece.
Surg Laparosc Endosc Percutan Tech. 2010 Apr;20(2):84-8. doi: 10.1097/SLE.0b013e3181d76ace.
Endoscopic sphincterotomy (ES) is the cornerstone of therapeutic ERCP and bleeding is one of its most frequent and serious complications. Monopolar coagulation has been used effectively for many causes of gastrointestinal hemorrhages. We investigated the efficacy and safety of endoscopically delivered monopolar coagulation through a polypectomy snare in patients with ES-induced bleeding not responding to injection treatment.
The study included 672 consecutive patients who underwent ES between June 2007 and January 2009. Bleeding patterns (trickle, oozing, spurting) were recorded. Patients with bleeding not responding to spray irrigation or injection of 0.9% NaCl+epinephrine 1: 10,000 solution were treated with monopolar coagulation. Complications related to the technique were assessed.
ES-induced bleeding occurred in 59 patients (8.78%). Visible bleeding patterns immediately after ES were: 32 trickle, 21 oozing, and 4 spurting. Delayed bleeding was observed in 2 patients. In 11 patients with intraprocedural bleeding (7 oozing and 4 spurting) not responding to spray irrigation and injection treatment with epinephrine solution, bleeding was successfully treated with monopolar coagulation. There were no procedure-related complications in this series.
Monopolar coagulation is an effective and safe treatment modality and is recommended as an alternative method to other therapeutic modalities for post-ES bleeding not responding to injection treatment.
内镜括约肌切开术（ES）是治疗性内镜逆行胰胆管造影术的基石，出血是其最常见且严重的并发症之一。单极电凝已有效应用于多种胃肠道出血原因。我们研究了通过息肉切除圈套器进行内镜下单极电凝治疗对注射治疗无反应的ES所致出血患者的疗效和安全性。
本研究纳入了2007年6月至2009年1月期间连续接受ES的672例患者。记录出血模式（点滴状、渗血、喷射状）。对喷雾冲洗或注射0.9%氯化钠+1:10000肾上腺素溶液无反应的出血患者采用单极电凝治疗。评估与该技术相关的并发症。
59例患者（8.78%）发生ES所致出血。ES后立即出现的可见出血模式为：32例点滴状、21例渗血、4例喷射状。2例患者出现延迟出血。11例术中出血（7例渗血和4例喷射状）对喷雾冲洗和肾上腺素溶液注射治疗无反应的患者，单极电凝成功治疗了出血。本系列中无与操作相关的并发症。
单极电凝是一种有效且安全的治疗方式，对于对注射治疗无反应的ES后出血，推荐作为其他治疗方式的替代方法。
