Arai Yoshinori, Ogawa Maiko, Arimoto Rikako, Ando Yoshitaka, Endo Daisuke, Nakada Tatsuya, Sugawara Ichiro, Yokoyama Hiroshi, Shimoyama Keiko, Inomata Hiroko, Kawahara Yosuke, Kato Masayuki, Arihiro Seiji, Hokari Atsushi, Saruta Masayuki
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University Katsushika Medical Center, Tokyo 105-8461, Japan.
Tekko Building Marunouchi Clinic, Tokyo 100-0005, Japan.
Medicina (Kaunas). 2021 Mar 31;57(4):321. doi: 10.3390/medicina57040321.
: Recent advances in endoscopic devices such as small bowel capsule endoscopy and balloon-assisted endoscopy have improved the level of medical care for small bowel bleeding. However, treating small bowel angioectasia remains challenging because repeated intermittent bleeding can occur from the multiple minute lesions (about 1 mm in size) that develop in a synchronous and metachronous manner. Here, we report a case of small bowel angioectasia in which capsule endoscopy performed early in a bleeding episode contributed to treatment. : A 66-year-old man with suspected small bowel bleeding underwent small bowel capsule endoscopy and balloon-assisted endoscopy with argon plasma coagulation hemostasis for a small intestinal angioectasia. Because small bowel bleeding recurred intermittently after the treatment, small bowel capsule endoscopy and balloon-assisted endoscopy were repeated when there was no bleeding, but no abnormalities were found. Subsequent small bowel capsule endoscopy during a bleeding episode revealed bloody intestinal fluid in the proximal small intestine. Peroral balloon-assisted endoscopy was performed 2 days after SBCE for detailed observation of the small intestinal mucosa at the suspected bleeding site, and there a 1-mm Dieulafoy's lesion with no active bleeding was identified. We performed argon plasma coagulation, and no bleeding was observed thereafter. : Small bowel capsule endoscopy immediately after bleeding onset can identify the bleeding source of multiple minute lesions in small bowel angioectasia.
近期，诸如小肠胶囊内镜和气囊辅助内镜等内镜设备的进展提高了小肠出血的医疗水平。然而，治疗小肠血管扩张症仍然具有挑战性，因为在同步和异时发生的多个微小病变（大小约1毫米）中可能会反复出现间歇性出血。在此，我们报告一例小肠血管扩张症病例，其中在出血发作早期进行的胶囊内镜检查有助于治疗。：一名疑似小肠出血的66岁男性接受了小肠胶囊内镜检查和气囊辅助内镜检查，并对小肠血管扩张症采用氩等离子体凝固止血。由于治疗后小肠出血间歇性复发，在无出血时重复进行小肠胶囊内镜检查和气囊辅助内镜检查，但未发现异常。随后在一次出血发作期间进行的小肠胶囊内镜检查显示近端小肠有血性肠液。在小肠胶囊内镜检查后2天进行经口气囊辅助内镜检查，以详细观察疑似出血部位的小肠黏膜，发现一处1毫米的Dieulafoy病变，无活动性出血。我们进行了氩等离子体凝固，此后未观察到出血。：出血发作后立即进行的小肠胶囊内镜检查可以识别小肠血管扩张症中多个微小病变的出血源。
