Ikeya Takashi, Ishii Naoki, Shimamura Yuto, Nakano Kaoru, Ego Mai, Nakamura Kenji, Takagi Koichi, Fukuda Katsuyuki, Fujita Yoshiyuki
Takashi Ikeya, Naoki Ishii, Yuto Shimamura, Kaoru Nakano, Mai Ego, Kenji Nakamura, Koichi Takagi, Katsuyuki Fukuda, Yoshiyuki Fujita, Department of Gastroenterology, St. Luke's International Hospital, Tokyo 104-8560, Japan.
World J Gastrointest Endosc. 2014 Oct 16;6(10):488-92. doi: 10.4253/wjge.v6.i10.488.
To investigate the safety and efficacy of endoscopic band ligation (EBL) for bleeding lesions in the small bowel.
This is a retrospective study evaluating EBL in six consecutive patients (three males, three females, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, jejunal bleeding diverticulum; 1, ileal Dieulafoy's lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding (within 30 d after EBL), and complications such as perforation and abscess formation. Follow-up endoscopies were performed in four patients.
Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and a repeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case (13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45 (range, 2-83) mo.
EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel.
探讨内镜下套扎术（EBL）治疗小肠出血性病变的安全性和有效性。
这是一项回顾性研究，评估了2009年5月至2014年2月期间连续治疗的6例患者（3例男性，3例女性，年龄46 - 86岁）的EBL治疗情况：十二指肠血管扩张症1例；空肠出血性憩室1例；回肠Dieulafoy病1例；回肠出血性憩室3例。评估了初始止血的成功率，并观察患者早期再出血情况（EBL后30天内）以及穿孔和脓肿形成等并发症。对4例患者进行了随访内镜检查。
所有6例患者通过EBL均成功实现初始止血。4例憩室病变的翻出不充分。1例回肠憩室在EBL后3天发生早期再出血，再次内镜检查发现O形圈套器移位，套扎部位形成溃疡。此次再出血采用保守治疗。该病例发生了晚期再出血（初始EBL后13个月和21个月），并进行了再次EBL。随访内镜检查显示，十二指肠出血病变患者套扎部位形成瘢痕，血管病变消失；3例患者的回肠憩室未解决。在中位随访期45（范围2 - 83）个月内，无需手术或经动脉栓塞，无任何并发症。
EBL是治疗小肠出血性病变止血的一种安全有效的内镜治疗方法。
