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Endoscopic band ligation device for bleeding gastric angiodysplasia

1999; Elsevier BV; Volume: 50; Issue: 4 Linguagem: Inglês

10.1016/s0016-5107(99)70101-x

1097-6779

Yukihiko Jo, Takayuki Matsumoto, Kunihiko Aoyagi, Yuji Yano, Atushi Kawasaki, Masatoshi Fujishima,

Esophageal and GI Pathology

Active bleeding from angiodysplasia in the upper GI tract is rare, although it is often life-threatening so as to require immediate hemostasis. Several types of endoscopic therapy for bleeding angiodysplasia have been described. However, there have been relatively few reports of angiodysplasia treated by endoscopic band ligation (EBL).1Campo R Brullet E. Endoscopic treatment of gastric angiodysplasia with elastic band ligation.Gastrointest Endosc. 1996; 43: 502-504Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 2Abi-Hanna D Williams SJ Gillespie PE Bourke MJ. Endoscopic band ligation for non-variceal non-ulcer gastrointestinal hemorrhage.Gastrointest Endosc. 1998; 48: 510-514Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar A 44-year-old woman with diabetes mellitus came to our hospital because of general fatigue. She had been found to have anemia 6 months earlier. Laboratory data showed marked microcytic hypochromatic anemia (hemoglobin 4.4 gm/dL). EGD revealed a small angiodysplasia in the upper body of the stomach. Technetium 99m–tagged red blood cell scintigraphy revealed accumulation of the radioactive isotope in the stomach. On the day of the scintigraphy, she developed hematemesis. Immediate upper endoscopy revealed a large blood clot and active bleeding from the angiodysplasia (Fig. 1A).We used an EBL device (Pneumo-Active EVL; Sumitomo, Tokyo, Japan) to obtain hemostasis in the same manner as for bleeding esophageal varices3Stiegmann GV Cambre T Sun JH. A new endoscopic elastic band ligating device.Gastrointest Endosc. 1986; 32: 230-233Abstract Full Text PDF PubMed Scopus (301) Google Scholar (Fig. 1B). After the procedure, bleeding from angiodysplasia ceased. During the subsequent 42 months, there were no signs of GI bleeding. Angiodysplasia is well recognized as a potential source of GI bleeding of obscure origin.4Machicado GA Jensen DM. Upper gastrointestinal angiomata: diagnosis and treatment.Gastrointest Endosc Clin N Am. 1991; 1: 241-262Google Scholar Endoscopic devices used for hemostasis include lasers, contact heat probe, monopolar electrocoagulation, and injection therapy. Each method has been reported to be effective for initial hemostasis, but problems such as delayed hemorrhage, post-coagulation syndrome, and perforation are also associated with these endoscopic procedures.4Machicado GA Jensen DM. Upper gastrointestinal angiomata: diagnosis and treatment.Gastrointest Endosc Clin N Am. 1991; 1: 241-262Google Scholar Contact probes have been widely accepted for treatment of bleeding angiodysplasias4Machicado GA Jensen DM. Upper gastrointestinal angiomata: diagnosis and treatment.Gastrointest Endosc Clin N Am. 1991; 1: 241-262Google Scholar because they are convenient and can target the bleeding point even in a tangential fashion. Nevertheless, when the probe is removed from the mucosa, mucosal injury can occur, and, as a result, recurrent bleeding may arise.1Campo R Brullet E. Endoscopic treatment of gastric angiodysplasia with elastic band ligation.Gastrointest Endosc. 1996; 43: 502-504Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar The EBL device remains attached to the ligated site for a few days and granulated tissue replaces the lesion.5Tseng C Burke S Connors P Green R Carr-Locke DL. Endoscopic band ligation for treatment of non-variceal upper gastrointestinal bleeding.Endoscopy. 1991; 23: 297-298Crossref PubMed Scopus (34) Google Scholar Therefore EBL rarely results in delayed hemorrhage or perforation.5Tseng C Burke S Connors P Green R Carr-Locke DL. Endoscopic band ligation for treatment of non-variceal upper gastrointestinal bleeding.Endoscopy. 1991; 23: 297-298Crossref PubMed Scopus (34) Google Scholar The EBL device has been increasingly applied for hemostasis in non-variceal GI bleeding.1Campo R Brullet E. Endoscopic treatment of gastric angiodysplasia with elastic band ligation.Gastrointest Endosc. 1996; 43: 502-504Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 2Abi-Hanna D Williams SJ Gillespie PE Bourke MJ. Endoscopic band ligation for non-variceal non-ulcer gastrointestinal hemorrhage.Gastrointest Endosc. 1998; 48: 510-514Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar, 5Tseng C Burke S Connors P Green R Carr-Locke DL. Endoscopic band ligation for treatment of non-variceal upper gastrointestinal bleeding.Endoscopy. 1991; 23: 297-298Crossref PubMed Scopus (34) Google Scholar Although it has been used in only a few cases of angiodysplasia, the outcomes have been good without further bleeding episodes, as in our case.1Campo R Brullet E. Endoscopic treatment of gastric angiodysplasia with elastic band ligation.Gastrointest Endosc. 1996; 43: 502-504Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 2Abi-Hanna D Williams SJ Gillespie PE Bourke MJ. Endoscopic band ligation for non-variceal non-ulcer gastrointestinal hemorrhage.Gastrointest Endosc. 1998; 48: 510-514Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar The EBL device can be easily applied in any part of the stomach, it is inexpensive, and moreover it has few complications.