Nakagome Shun, Koizumi Eriko, Goto Osamu, Kitamura Michika, Kawami Noriyuki, Higuchi Kazutoshi, Onda Takeshi, Omori Jun, Akimoto Naohiko, Iwakiri Katsuhiko
Department of Gastroenterology Nippon Medical School, Graduate School of Medicine Tokyo Japan.
Endoscopy Center Nippon Medical School Hospital Tokyo Japan.
DEN Open. 2023 Jan 9;3(1):e207. doi: 10.1002/deo2.207. eCollection 2023 Apr.
A 78-year-old man was admitted to our hospital with a tarry stool. Esophagogastroduodenoscopy identified tiny oozing on the greater curvature at the antrum. Despite repeated endoscopic hemostasis by coagulation and clipping, rebleeding occurred. On the third rebleeding, we performed endoscopic hand suturing to completely close the ulcer surface. Biopsy showing massive infiltration of eosinophils at the ulcer edge indicated eosinophilic gastritis. After the endoscopic closure by endoscopic hand suturing, the patient had no symptoms of bleeding thereafter and was discharged 19 days after the procedure by taking oral prednisolone. The patient remained well and was continuously treated with a small dose of steroids in outpatient. This is the first case report of the successful application of endoscopic hand suturing to a refractory hemorrhagic ulcer. Further accumulation of clinical experiences is desired to confirm the usefulness of this technique for the prevention of refractory ulcer bleeding.
一名78岁男性因柏油样便入住我院。食管胃十二指肠镜检查发现胃窦大弯处有微小渗血。尽管反复进行内镜下凝固和夹闭止血，但仍再次出血。第三次出血时，我们进行了内镜手工缝合以完全封闭溃疡面。溃疡边缘活检显示嗜酸性粒细胞大量浸润，提示嗜酸性胃炎。内镜手工缝合封闭溃疡后，患者此后无出血症状，术后19天口服泼尼松龙后出院。患者情况良好，门诊继续接受小剂量类固醇治疗。这是首例成功应用内镜手工缝合治疗难治性出血性溃疡的病例报告。需要进一步积累临床经验以证实该技术在预防难治性溃疡出血方面的有效性。
