Department of Gastroenterology, Hôpital Nord, Marseille, France.
Endoscopy. 2012 May;44(5):539-42. doi: 10.1055/s-0031-1291609. Epub 2012 Mar 2.
Recent developments in therapeutic endoscopic ultrasound (EUS) have enabled new approaches to the management of refractory gastrointestinal bleeding, including EUS-guided sclerotherapy and vessel embolization. Few cases have been reported in the literature. Eight patients were admitted for severe, refractory gastrointestinal bleeding, seven of whom were actively bleeding. Causes of bleeding were gastric varices secondary to portal hypertension (n = 3); gastroduodenal artery aneurysm or fundal aneurysmal arterial malformation (n = 3); and Dieulafoy's ulcer (n = 2); the latter five patients having arterial bleeding. During the procedures, the bleeding vessel was punctured with a 19-gauge needle then injected with a sclerosing agent (cyanoacrylate glue [n = 6] or polidocanol 2 % [n = 2]) under Doppler control. The median follow-up time was 9 months (3 - 18 months). In all 10 endoscopic procedures were performed. The procedure was successful at the first attempt in seven out of eight patients (87.5 %). No clinical complications were observed, although in one case there was diffusion of cyanoacrylate in the hepatic artery. The seven successful cases all showed immediate and complete disappearance of the Doppler flow signal at the end of the procedure. This retrospective study highlights the utility of EUS-guided vascular therapy. However, more large randomized studies should be conducted to confirm these results.
近年来，治疗性内镜超声（EUS）的发展为难治性胃肠道出血的治疗提供了新的方法，包括 EUS 引导下的硬化治疗和血管栓塞。文献中报道的病例很少。8 名患者因严重、难治性胃肠道出血而入院，其中 7 名患者正在出血。出血的原因包括门静脉高压引起的胃静脉曲张（n = 3）；胃十二指肠动脉动脉瘤或胃底动脉瘤性动脉畸形（n = 3）；和杜尔福溃疡（n = 2）；后 5 例患者有动脉出血。在手术过程中，使用 19 号针穿刺出血血管，然后在多普勒控制下注入硬化剂（氰基丙烯酸酯胶[n = 6]或 2%聚多卡醇[n = 2]）。中位随访时间为 9 个月（3-18 个月）。共进行了 10 次内镜检查。在 8 名患者中的 7 名（87.5%），首次尝试即成功完成了该手术。未观察到临床并发症，但有 1 例在肝动脉内有氰基丙烯酸酯扩散。7 例成功的病例在手术结束时均立即完全消失了多普勒血流信号。这项回顾性研究强调了 EUS 引导下血管治疗的实用性。然而，应该进行更多的大型随机研究来证实这些结果。
