Hartz Kayla M, Lee Roland Y, Walsh Leonard T, Dixon Matthew E B, Moyer Matthew T
Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
VideoGIE. 2021 Jun 22;6(10):481-483. doi: 10.1016/j.vgie.2021.05.010. eCollection 2021 Oct.
There is a significant bleeding risk after gastric endoscopic submucosal dissection (ESD) and EMR cases. This case series describes the use of an endoscopic hemostasis spray, which is not typically used to treat this type of bleeding, after multiple attempts with other modalities failed.
We present 2 patient cases of ESD and EMR used to treat a gastric adenoma (case 1) and 2 gastric hyperplastic masses (case 2) with refractory bleeding after use of multiple other treatment modalities. Both patients were not surgical candidates because of their medical comorbidities.
Bleeding was eventually controlled with the use of endoscopic hemostasis spray after attempts were made using SB Knife Jr tip, Coagrasper Hemostatic Forceps, Argon Photocoagulation, and scope tamponade.
In very specific cases, endoscopic hemostasis spray may have some utility for refractory bleeding after dissection of gastric lesions. After using this spray, it became technically challenging to suture endoscopically because of the mud-like quality of the hemostasis material.
胃内镜黏膜下剥离术（ESD）和内镜黏膜切除术（EMR）后存在显著的出血风险。本病例系列描述了在多次尝试其他方法失败后，使用一种通常不用于治疗此类出血的内镜止血喷雾剂的情况。
我们呈现了2例ESD和EMR患者病例，分别用于治疗胃腺瘤（病例1）和2个胃增生性肿块（病例2），在使用多种其他治疗方法后出现难治性出血。由于患者的内科合并症，这两名患者均不适合手术治疗。
在尝试使用SB Knife Jr刀头、Coagrasper止血钳、氩离子凝固术和内镜压迫止血后，最终使用内镜止血喷雾剂控制了出血。
在非常特殊的情况下，内镜止血喷雾剂可能对胃病变剥离后的难治性出血有一定作用。使用这种喷雾剂后，由于止血材料呈泥状，内镜缝合在技术上变得具有挑战性。
