Tamari Hirosato, Aoyama Taiki, Shigita Kenjiro, Asayama Naoki, Fukumoto Akira, Mukai Shinichi, Nagata Shinji
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Endosc Int Open. 2020 Jan;8(1):E64-E69. doi: 10.1055/a-1027-6830. Epub 2020 Jan 8.
Unsatisfactory detectability of a previously bleeding diverticulum by colonoscopy results from difficulty in precisely locating the target lesion, even with presence of an extravasation on contrast-enhanced computed tomography (CECT). This study aimed to evaluate the usefulness of the step-clipping method to overcome this limitation. Step-clipping was indicated for patients with colonic diverticular bleeding and presence of extravasation on CECT, but with absence of active bleeding on subsequent colonoscopy. The target diverticulum was identified by comparing computed tomography images before and after step clipping, which provided a positional relationship between each clip and the target lesion. Based on data from 21 consecutive cases meeting our inclusion criteria (14 men and 7 women; mean age, 73.2 years), the target diverticulum was endoscopically identified in 20 cases (95 %), in a median time of 5 minutes, and successfully treated. No adverse events were observed with the step-clipping method. Step-clipping provided easy guidance to the target site for treatment in a short time, despite spontaneous cessation of bleeding at the diverticulum.
即使在对比增强计算机断层扫描（CECT）上存在造影剂外渗，结肠镜检查对先前出血憩室的检测效果仍不理想，原因在于精确定位目标病变存在困难。本研究旨在评估阶梯夹闭法克服这一局限性的有效性。阶梯夹闭法适用于患有结肠憩室出血且在CECT上存在造影剂外渗，但随后结肠镜检查未发现活动性出血的患者。通过比较阶梯夹闭前后的计算机断层扫描图像来确定目标憩室，这提供了每个夹子与目标病变之间的位置关系。基于连续21例符合我们纳入标准的病例数据（14例男性和7例女性；平均年龄73.2岁），20例（95%）在内镜下成功识别出目标憩室，中位时间为5分钟，并成功进行了治疗。阶梯夹闭法未观察到不良事件。尽管憩室出血已自行停止，但阶梯夹闭法仍能在短时间内为治疗目标部位提供简便的引导。
