Wedi Edris, Bounnah Mohamed, Memeo Riccardo, Jung Carlo
Department of Gastroenterology and Gastrointestinal Oncology, Göttingen University Hospital, Göttingen, Germany.
Department of Gastroenterology, Nouvel Hôpital Civil, University Hospitals, Strasbourg, France.
Clin Endosc. 2017 Nov;50(6):598-601. doi: 10.5946/ce.2017.024. Epub 2017 Jun 1.
Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot. A combined endoscopic and surgical treatment was initiated, including gastrotomy for blood clot removal, surgical transgastric suturing, endoscopic over-the-scope clip (OTSC) placement and hemospray application. Postoperative endoscopic visualization showed effective bleeding control. The patient unfortunately died due to causes unrelated to the treatment. This case shows that a minimal invasive combination of endoscopic and surgical techniques can be an alternative treatment for severe upper GI bleeding in critically ill and anticoagulated patients.
胃肠道出血是心脏辅助装置植入术后常见的并发症。出血原因是多因素的。内镜治疗是首选治疗方法，而对于这些重症患者应避免进行侵入性操作。我们报告了一例65岁男性患者，在植入左心室辅助装置（LVAD）和右心室辅助装置（RVAD）并进行治疗性抗凝后发生严重胃肠道出血。内镜检查发现多个胃出血源，但由于血凝块较大无法有效治疗。于是启动了内镜和手术联合治疗，包括剖腹胃切开术清除血凝块、经胃手术缝合、内镜套扎夹（OTSC）置入和喷洒止血剂。术后内镜检查显示出血得到有效控制。不幸的是，患者因与治疗无关的原因死亡。该病例表明，内镜和手术技术的微创联合可作为重症和抗凝患者严重上消化道出血的替代治疗方法。
