Jejunal variceal bleeding at the site of hepaticojejunostomy after pancre-aticoduodenectomy due to portal hypertension caused by extrahepatic portal vein obstruction is a life-threatening complication and is very diff...Jejunal variceal bleeding at the site of hepaticojejunostomy after pancre-aticoduodenectomy due to portal hypertension caused by extrahepatic portal vein obstruction is a life-threatening complication and is very difficult to treat.Pharma-cotherapy,endoscopic methods,transcatheter embolization of veins supplying the jejunal afferent loop,portal venous stenting,and surgical procedures can be used for the treatment of jejunal variceal bleeding.Nevertheless,the optimal mana-gement strategy has not yet been established,which is due to the lack of ran-domized controlled trials involving a large cohort of patients necessary for their development.展开更多
AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastro...AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezia,2 had both melena and hematochezia,1 had anemia and dizziness.DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000,Dieulafoylike lesions in 4 patients treated by deploying hemoclips on the vessels,colonic diverticula in 2 patients,and duodenal diverticula in 3 patients,respectively.Of the 2patients who underwent surgical intervention,1 had a large diverticulum and was referred by the surgeon for DBE,1 received endoscopic therapy but failed due to massive bleeding.One patient had a second DBE for recurrent hemorrhage 7 mo later,which was successfully treated with a repeat endoscopy.The mean follow-up time of patients was 14.7 ± 7.8 mo.CONCLUSION:DBE is a safe and effective treatment modality for jejunal diverticular bleeding.展开更多
文摘Jejunal variceal bleeding at the site of hepaticojejunostomy after pancre-aticoduodenectomy due to portal hypertension caused by extrahepatic portal vein obstruction is a life-threatening complication and is very difficult to treat.Pharma-cotherapy,endoscopic methods,transcatheter embolization of veins supplying the jejunal afferent loop,portal venous stenting,and surgical procedures can be used for the treatment of jejunal variceal bleeding.Nevertheless,the optimal mana-gement strategy has not yet been established,which is due to the lack of ran-domized controlled trials involving a large cohort of patients necessary for their development.
基金Supported by Department of Gastroenterology and Hepatology,Chang Gung Memorial Hospital
文摘AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezia,2 had both melena and hematochezia,1 had anemia and dizziness.DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000,Dieulafoylike lesions in 4 patients treated by deploying hemoclips on the vessels,colonic diverticula in 2 patients,and duodenal diverticula in 3 patients,respectively.Of the 2patients who underwent surgical intervention,1 had a large diverticulum and was referred by the surgeon for DBE,1 received endoscopic therapy but failed due to massive bleeding.One patient had a second DBE for recurrent hemorrhage 7 mo later,which was successfully treated with a repeat endoscopy.The mean follow-up time of patients was 14.7 ± 7.8 mo.CONCLUSION:DBE is a safe and effective treatment modality for jejunal diverticular bleeding.
