Kondo Masahiro, Nagasue Tomohiro, Torisu Takehiro, Miyazono Satoshi, Matsuno Yuichi, Nagahata Takahisa, Hashimoto Toru, Fujino Takeo, Shiose Akira, Kitazono Takanari
Department of Medicine and Clinical Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
Department of Cardiovascular Medicine Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
DEN Open. 2024 Apr 17;4(1):e369. doi: 10.1002/deo2.369. eCollection 2024 Apr.
We herein describe a 49-year-old man with severe heart failure due to fulminant myocarditis who underwent left ventricular assist device implantation and received clopidogrel and warfarin as antithrombotic agents. The patient developed anemia secondary to chronic bleeding gastric hyperplastic polyps, necessitating endoscopic mucosal resection. Despite attempts to manage post-endoscopic mucosal resection bleeding from a gastric ulcer by endoscopic hemostasis using hemostatic forceps, local hemostatic agents, and polyglycolic acid sheets, the bleeding persisted. Hemostasis of the refractory bleeding was finally achieved by endoscopic hand-suturing of the ulcer. One month later, the ulcer was almost completely scarred. This case has important clinical value in that it demonstrates the efficacy of endoscopic hand-suturing even in challenging cases such as refractory bleeding gastric ulcers in patients with left ventricular assist devices.
我们在此描述一名49岁因暴发性心肌炎导致严重心力衰竭的男性患者，该患者接受了左心室辅助装置植入术，并接受氯吡格雷和华法林作为抗血栓药物。患者因慢性出血性胃增生性息肉继发贫血，需要进行内镜黏膜切除术。尽管尝试通过使用止血钳、局部止血剂和聚乙醇酸片进行内镜止血来处理内镜黏膜切除术后胃溃疡出血，但出血仍持续。最终通过内镜下对溃疡进行手工缝合实现了难治性出血的止血。1个月后，溃疡几乎完全瘢痕化。该病例具有重要的临床价值，因为它证明了即使在具有挑战性的病例中，如左心室辅助装置患者的难治性胃溃疡出血，内镜手工缝合也具有疗效。
