Grammatopoulos Anastasios, Petraki Kalliopi, Katsoras George
Department of Gastroenterology (Anastasios Grammatopoulos, George Katsoras), Metropolitan Hospital, Athens, Greece.
Department of Pathology (Kalliopi Petraki), Metropolitan Hospital, Athens, Greece.
Ann Gastroenterol. 2013;26(3):264-266.
A 20-year-old woman was admitted with iron deficiency anemia and history of melena. Upper endoscopy demonstrated normal esophagus, stomach and proximal duodenum. At colonoscopy, two bluish pedunculated angiectatic polypoid lesions (1 to 2 cm in diameter) were noted due to blue rubber bleb nevus syndrome (BRBNS). The small intestine was screened for further lesions with the use of capsule endoscopy. The capsule identified four more lesions at the proximal jejunum. The small bowel lesions were smaller, 0.5 to 1cm in diameter at their bases. We performed enteroscopy to approach the jejunal lesions. All lesions were ligated in one session using the band ligation technique with multi-band ligator device. A colonoscopy was performed and detachable snares - endoloops were inserted at the colonic lesions. Three weeks following the interventions further endoscopic evaluations were performed; they revealed scars at all sites treated with either technique. No bleeding or new venous malformations were observed. In conclusion, we report a dual technique resection method on a patient with BRBNS. The choice of resection technique depended on the lesion characteristics. Both band ligation and endoloop can be safely used for polypoid BRBNS lesions at the jejunum and colon respectively.
一名20岁女性因缺铁性贫血和黑便病史入院。上消化道内镜检查显示食管、胃和十二指肠近端正常。结肠镜检查时，发现了两个蓝色带蒂的血管扩张性息肉样病变（直径1至2厘米），诊断为蓝色橡皮疱痣综合征（BRBNS）。使用胶囊内镜对小肠进行进一步病变筛查。胶囊内镜在空肠近端又发现了4个病变。小肠病变较小，基部直径为0.5至1厘米。我们进行了小肠镜检查以接近空肠病变。使用多环结扎器通过套扎技术在一次手术中对所有病变进行了结扎。进行了结肠镜检查，并在结肠病变处插入了可拆卸圈套器——内镜圈套。干预措施实施三周后，进行了进一步的内镜评估；结果显示，所有采用这两种技术治疗的部位均有瘢痕形成。未观察到出血或新的静脉畸形。总之，我们报告了一例对BRBNS患者采用的双重技术切除方法。切除技术的选择取决于病变特征。套扎和内镜圈套分别可安全用于空肠和结肠的息肉样BRBNS病变。
