Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China.
World J Gastroenterol. 2017 Nov 21;23(43):7746-7755. doi: 10.3748/wjg.v23.i43.7746.
To focus on procedure-related complications, evaluate their incidence, analyze the reasons and discuss the solutions.
Overall, 628 endoscopic gastric variceal obturation (EGVO) procedures (case-times) with NBC were performed in 519 patients in the Department of Endoscopy of the Third Affiliated Hospital of Sun Yat-Sen University from January 2011 to December 2016. The clinical data of patients and procedure-related complications of EGVO were retrospectively analyzed.
In the 628 EGVO procedures, sticking of the needle to the varix occurred in 9 cases (1.43%), including 1 case that used lipiodol-diluted NBC and 8 cases that used undiluted NBC ( = 0.000). The needle was successfully withdrawn in 8 cases. Large spurt bleeding occurred in one case, and hemostasis was achieved by two other injections of undiluted glue. The injection catheter became blocked in 17 cases (2.71%) just during the injection, and 4 cases were complicated with the needle sticking to the varix. Large glue adhesion to the endoscope resulted in difficulty withdrawing the endoscope in 1 case. Bleeding from multiple sites was observed in the esophagus and gastric cardia after the endoscope was withdrawn. Hemostasis was achieved by 1% aethoxysklerol injection and intravenous somatostatin. The ligation device stuck to the varices in two cases during the subsequent endoscopic variceal ligation. In one case, the ligation device was successfully separated from the esophageal varix after all bands were released. In another case, a laceration of the vein and massive bleeding were observed. The bleeding ceased after 1% aethoxysklerol injection.
Although EGVO with tissue glue is usually safe and effective, a series of complications can occur during the procedure that may puzzle endoscopists. There is no standard operating procedure for addressing these complications. The cases described in the current study can provide some reference for others.
关注与操作相关的并发症，评估其发生率，分析原因并探讨解决方案。
回顾性分析中山大学附属第三医院内镜科 2011 年 1 月至 2016 年 12 月期间对 519 例患者共行 628 例内镜下胃静脉曲张套扎术（EGVO）的临床资料，分析 EGVO 操作相关并发症的发生情况及原因。
628 例 EGVO 中，有 9 例（1.43%）发生针尖粘于曲张静脉，其中 1 例使用碘化油稀释 NBC，8 例使用未稀释 NBC（=0.000），8 例针尖成功退出，1 例出现大出血，再次注射未稀释 NBC 2 支后出血停止。17 例（2.71%）在注胶过程中注射导管堵塞，其中 4 例合并针尖粘于曲张静脉，1 例因大量胶黏附于内镜，导致内镜退出困难。1 例术后退镜时发现食管、胃底多个部位渗血，予 1%乙氧硬化醇注射及静脉生长抑素后出血停止。2 例后续行内镜下食管静脉曲张套扎术时，结扎器均粘于曲张静脉，1 例所有套扎环释放后，结扎器与食管曲张静脉分离成功，另 1 例出现静脉撕裂大出血，予 1%乙氧硬化醇注射后出血停止。
尽管组织胶行 EGVO 通常安全有效，但操作过程中仍可能出现一系列并发症，给内镜医生带来困扰，目前尚无处理这些并发症的标准操作流程，本研究中描述的病例可为相关处理提供参考。
