No abstract available.
Hemorrhage* ; Hemostasis, Endoscopic* ; Humans

BACKGROUND/AIMS: Dieulafoy's lesion is a rare cause of massive upper gastrointestinal bleeding, most commonly in the proximal stomach. Although the mechanical hemostatic method has been widely used, it is difficult to access for complete application. This study evaluated the utility of a positional change in patients with a bleeding Dieulafoy's lesion. METHODS: Between January 2003 and March 2004, 15 patients with a bleeding Dieulafoy's lesion were randomly assigned to either a positional change group (right decubitus or supine, n=7) or a left decubitus group (n=8). The demographic characteristics, endoscopic variables, and clinical outcomes were analyzed. RESULTS: The patients' characteristics at entry were similar in both groups. Initial hemostasis was achieved in all patients. Recurrent bleeding developed in only one patients in the left decubitus group. The mean procedure time was significantly shorter in the positional change group than in the left decubitus group (4.5+/-3.4 min vs. 7.4+/-5.2 min, p<0.05). The ineffective hemoclip number (respectively, 0.3+/-0.1 vs. 1.4+/-1.2, p<0.05) was significantly different in the two groups. No major procedure-related complications occurred in the positional change group. CONCLUSIONS: Endoscopic hemostasis with a positional change is an effective and safe method for treating in a bleeding Dieulafoy's lesion.
Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic* ; Humans ; Stomach

The hemostatic effect of endoscopic microwave coagulation method for upper gastrointestinal bleeding was evaluated clinically. Hemostasis over 72 hours was achieved in 18 of 20 cases (90%) with upper gastrointestinal bleeding by the endoscopic microwave coagulation method. It is noteworthy that this method was effective in all 4 cases of pulsatile bleeding from exposed vessels. We conclude that this method is useful for emergency endoscopic hemostasis on upper gastrointestinal bleeding, especially bleeding from exposed vessels.
Emergencies ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Microwaves*

A duodenal diverticulum is common and usually originates in the second portion of the duodenum. The majority of diverticula are asymptomatic; however, they may sometimes present with symptoms such as obstruction, hemorrhage, perforation, jaundice and pancreatitis. Active bleeding from a duodenal diverticulum is rare, and moreover, Dieulafoy's lesion as a cause is quite rare with very few cases reported so far. The use of endoscopic methods instead of surgery in achieving hemostasis has been on the increase with the widespread use and improvement in endoscope instrumentation and accessories. Of these methods, the use of endoscopic hemoclipping for Dieulafoy's lesion is considered more effective and safe than the use of other methods, such as injection and thermal methods. We report here a case of a bleeding Dieulafoy's lesion in a duodenal diverticulum treated by endoscopic hemoclipping.
Diverticulum* ; Duodenum ; Endoscopes ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Jaundice ; Pancreatitis

Endoscopy has its role in the primary diagnosis and management of acute non-variceal upper gastrointestinal bleeding. Main roles of endoscopy are identifying high risk stigmata lesion, and performing endoscopic hemostasis to lower the rebleeding and mortality risks. Early endoscopy within the first 24 hours enables risk classification according to clinical and endoscopic criteria, which guide safe and prompt discharge of low risk patients, and improve outcomes of high risk patients. Techniques including injection therapy, ablative therapy and mechanical therapy have been studied over the recent decades. Combined treatment is more effective than injection treatment, and single treatment with mechanical or thermal method is safe and effective in peptic ulcer bleeding. Specific treatment and correct decisions are needed in various situations depending on the site, location, specific characteristics of lesion and patient's clinical conditions.
Burns ; Christianity ; Endoscopy ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Peptic Ulcer

Although endoscopic hemostasis remains initial treatment modality for nonvariceal gastrointestinal (GI) bleeding, severe bleeding despite endoscopic management occurs in 5% to 10% of the patients, requiring surgery or transcatheter arterial embolization (TAE). TAE is now considered the first-line therapy for massive GI bleeding refractory to endoscopic management. GI endoscopists need to be familiar with indications, principles, outcomes, and complications of TAE, as well as embolic materials available.
Gastrointestinal Tract ; Hemorrhage ; Hemostasis, Endoscopic ; Humans

The endoscopic retrograde cholangiopancreatography (ERCP) has become a commonly performed endoscopic procedure in biliary pathology. ERCP is a relatively safe procedure. however, there are chance of potentially severe complications; pancreatitis, hemorrhage, infection, and perforation. Duodenal perforation, uncommon but severe complication of ERCP, occurred in less than 1% of most series. According to the related mechanism, anatomical location, and the severity of injury, three to four distinct types of perforations have been described. We experienced the barotrauma associated duodenal perforation during endoscopic hemostasis in patient with EST site bleeding. This duodenal perforation was related with excessive air inflation to maintain the patency of a lumen. Endoscopists performing ERCP should bear in mind that continued air inflation may lead to duodenal perforation.
Barotrauma ; Cholangiopancreatography, Endoscopic Retrograde ; Hemorrhage* ; Hemostasis, Endoscopic* ; Humans ; Inflation, Economic ; Pancreatitis ; Pathology ; Sphincterotomy, Endoscopic

Rectal Dieulafoy's lesion (DL) is rare cause of lower gastrointestinal bleeding. Because of its rarity, there is no consensus on the optimal endoscopic hemostasis technique for rectal DL. We analyzed six patients who underwent endoscopic management for rectal DL after presenting with hematochezia at a single institute over 10 years. Of the six patients, three underwent endoscopic band ligation (EBL) and three underwent endoscopic hemoclip placement (EHP). Only one patient was treated with thermocoagulation. There were no immediate complications in any of the patients. None of the patients required a procedure or surgery for the treatment of rebleeding. Mean procedure times of EBL and EHP were 5.25 minutes and 7 minutes, respectively. Both EHP and EBL are shown to be effective in the treatment of bleeding rectal DL. We suggest that EBL may have potential as the preferred therapy owing to its superiority in technical and economic aspects, especially in elderly and high-risk patients.
Aged ; Consensus ; Electrocoagulation ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Ligation

BACKGROUND/AIMS: One major complication of endoscopic submucosal dissection (ESD) is delayed bleeding. Most hospitals routinely perform second-look endoscopy to reduce the chances of delayed bleeding without solid evidence supporting the practice. The aim of this study was to evaluate whether second-look endoscopy prevents delayed bleeding and to verify the clinicopathological features of delayed bleeding to determine how to identify lesions that may require second-look endoscopy. METHODS: We investigated 440 lesions in 397 patients who underwent ESD for gastric neoplasm from January 2008 to June 2010. Two-thirds of the enrolled cases were adenomas, and 290 lesions were located in the lower portion of the stomach. Clinically evident bleeding from mucosal defects 24 hours after ESD was considered as delayed bleeding. We reviewed the data, including the characteristics of patients, lesions, and procedures. Furthermore, the rate of delayed bleeding before and after second-look endoscopy, performed within three days of ESD, was investigated to determine the utility of second-look endoscopy. RESULTS: Delayed bleeding was evident in 9 of 440 lesions (2.0%), all of which underwent endoscopic hemostasis. The only significant factor predicting delayed bleeding was resected specimen over 40 mm in size (p=0.003). Delayed bleeding occurred in 8 of 9 cases (89%) before the second-look endoscopy, which was performed within 72 hours after ESD. CONCLUSIONS: In this study, second-look endoscopy may be useful for preventing post-ESD bleeding, especially when resected specimens are over 40 mm in size.
Adenoma ; Endoscopy ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Stomach ; Stomach Neoplasms

An intramural hematoma of the stomach usually results from trauma. Gastric intramural hematomas may also occur in patients with bleeding disorders who are receiving anticoagulation therapy or after an endoscopic procedure. Here, we describe a case of a gastric intramural hematoma after endoscopic hemostasis for gastric ulcer bleeding in a patient medicated with aspirin.
Aspirin ; Epinephrine ; Hematoma ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Stomach ; Stomach Ulcer