Morris A J, Mokhashi M, Straiton M, Murray L, Mackenzie J F
Department of Gastroenterology, Glasgow Royal Infirmary, Scotland.
Gastrointest Endosc. 1996 Oct;44(4):394-7. doi: 10.1016/s0016-5107(96)70087-1.
Blood loss from the small bowel is a significant cause of obscure gastrointestinal bleeding. Small bowel angiodysplasia may be the source of bleeding in 30% to 40% of patients with this problem. In other areas of the bowel, angiodysplasia has been effectively treated by endoscopic methods.
We used a 1.7 meter push enteroscope and heater probe ablation to examine and treat 11 transfusion-dependent patients with significant bleeding from small bowel angiodysplasia. Patients had push enteroscopy to target all lesions identified and had follow-up hemoglobin and fecal occult blood tests for a minimum of 6 months after final enteroscopy.
There were a median of 2 (range 1 to 7) small bowel lesions per patient. Patients required a median of 1 (range 1 to 5) examination to treat lesions identified at enteroscopy. Following therapy, hemoglobin levels rose significantly from a median of 8.5 (range 5.3 to 10.6) gm/dL) to a median of 13.5 (range 7.6 to 16.5) gm/dL (p < 0.01 Wilcoxon matched pair signed rank test).
Push enteroscopy and heater probe ablation offer potential therapy for bleeding from small bowel angiodysplasia and result in reduction of blood loss and transfusion requirements along with a significant improvement in levels of hemoglobin.
小肠出血是不明原因胃肠道出血的一个重要原因。小肠血管发育异常可能是30%至40%患有此问题患者的出血来源。在肠道的其他部位，血管发育异常已通过内镜方法得到有效治疗。
我们使用1.7米的推进式小肠镜和热探头消融术来检查和治疗11例因小肠血管发育异常而严重出血且依赖输血的患者。患者接受推进式小肠镜检查以针对所有识别出的病变，并在最后一次小肠镜检查后至少6个月进行血红蛋白和粪便潜血试验随访。
每位患者小肠病变的中位数为2个（范围为1至7个）。患者治疗小肠镜检查中识别出的病变平均需要1次（范围为1至5次）检查。治疗后，血红蛋白水平从中位数8.5（范围为5.3至10.6）克/分升显著升至中位数13.5（范围为7.6至16.5）克/分升（Wilcoxon配对符号秩和检验，p<0.01）。
推进式小肠镜检查和热探头消融术为小肠血管发育异常出血提供了潜在的治疗方法，可减少失血和输血需求，并显著提高血红蛋白水平。
