内窥镜治疗闭塞性坏死收集中活动性动脉出血

Q3 Medicine

VideoGIE Pub Date : 2025-10-01 DOI:10.1016/j.vgie.2025.05.013

Matthew Eganhouse MD, Agnieszka Maniak MD, Kanika Garg MD, Thomas Wang MD, Neal A. Mehta MD, Christopher G. Chapman MD, Irving Waxman MD, Ajaypal Singh MD

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引用次数: 0

摘要

背景和目的通过腔内金属支架（LAMS）引流壁闭塞性坏死（WON）和随后的内镜下坏死切除术相关的出血是该手术的已知不良事件。通常，这些出血是通过介入放射学来处理的。本病例展示了成功的内镜下处理从WON腔出血。方法1例45岁女性患者接受eus引导下膀胱吻合术治疗大面积症状性WON。手术后6天，她出现了呕血。计算机断层血管造影显示WON腔内有血液制品，但未见动脉外渗。我们决定对EGD进行内镜评估。结果在EGD期间，广泛的凝块提取和LAMS的去除允许在WON腔中发现脉动血管。使用凝血钳、止血夹结扎血管和肽基质凝胶进行治疗。她没有再出血，静脉积液也解决了。结论：本病例描述了成功的内镜治疗WON腔内出血。通常情况下，放置LAMS后的出血是由介入放射学处理的。然而，当影像学未显示活跃的动脉外渗或间歇性出血时，应考虑内镜治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Endoscopic management of active arterial bleeding in walled-off necrosis collection

Background and Aims

Bleeding related to drainage of walled-off necrosis (WON) via a lumen-apposing metal stent (LAMS) and subsequent endoscopic necrosectomy is a known adverse event of the procedure. Typically, these bleeds are managed by interventional radiology. This case demonstrates successful endoscopic management of bleeding from a WON cavity.

Methods

A 45-year-old female underwent EUS-guided cystagsastrostomy with a LAMS for a large, symptomatic WON collection. Six days after the procedure, she presented with hematemesis. Computed tomography angiography showed blood products in the WON cavity but no active arterial extravasation. The decision was made to pursue endoscopic evaluation with EGD.

Results

During EGD, extensive clot extraction and removal of the LAMS allowed discovery of a pulsatile vessel in the WON cavity. This was treated with coagulation grasper forceps, ligation of vessel with hemostatic clips, and peptide matrix gel. She had no further bleeding, and WON collection resolved.

Conclusions

This case portrays successful endoscopic therapy for bleeding within a WON cavity. Normally, bleeding after placement of a LAMS is managed by interventional radiology. However, endoscopic therapy should be considered when imaging does not reveal active arterial extravasation or if the bleeding is intermittent in nature.

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.