RESUMEN
BACKGROUND AND STUDY AIMS: Early reports of urgent colonoscopy in acute lower intestinal bleeding suggest a role for endoscopic therapy for bleeding colonic lesions, but scant data exist on bleeding diverticula. We report our experience with endoscopic hemostasis in acute diverticular bleeding. PATIENTS AND METHODS: Bleeding diverticula were identified on urgent diagnostic endoscopy in five patients with acute gastrointestinal bleeding, two in the duodenum, and three in the colon. All patients had co-morbid conditions preventing more conventional therapeutic approaches. The five cases are described, including the technique of endoscopic hemostasis and outcome. RESULTS: Endoscopic therapy using epinephrine injection, thermal cautery and/or laser therapy successfully induced hemostasis in all patients. One patient died of co-morbid illness during the hospital stay, while the remaining four patients had no recurrent bleeding over a mean follow-up period of 20.6 months. CONCLUSION: Endoscopic therapy of bleeding diverticula is technically possible when the culprit diverticulum can be identified. This therapeutic modality may have a place in debilitated patients in whom other more invasive procedures are contraindicated, but further experience is needed to establish its safety.
Asunto(s)
Divertículo del Colon/complicaciones , Hemorragia Gastrointestinal/terapia , Hemostasis Endoscópica/métodos , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Divertículo del Colon/diagnóstico , Endoscopía del Sistema Digestivo , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Fístula/etiología , Fístula Gástrica/etiología , Cardiopatías/etiología , Úlcera Péptica/complicaciones , Pericardio , Neumopericardio/etiología , Anciano , Anciano de 80 o más Años , Endoscopía Gastrointestinal , Femenino , Fístula/patología , Fístula Gástrica/patología , Cardiopatías/patología , Humanos , Pericardio/patología , Neumopericardio/patologíaAsunto(s)
Glándulas Duodenales/patología , Enfermedades Duodenales/terapia , Endoscopía/métodos , Hemorragia Gastrointestinal/terapia , Hamartoma/terapia , Hemostasis Endoscópica/métodos , Adulto , Terapia Combinada , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/cirugía , Estudios de Seguimiento , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Hamartoma/complicaciones , Hamartoma/cirugía , Humanos , MasculinoRESUMEN
Complicated gastroesophageal reflux disease may be seen in a variety of congenital developmental syndromes, but progression of Barrett's metaplasia to adenocarcinoma is rare. We report the first case of esophageal adenocarcinoma in a young adult with Cornelia de Lange syndrome who had long-standing gastroesophageal reflux disease. We review the literature concerning Barrett's metaplasia in children and make recommendations for surveillance.