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Enteroscopic Diagnosis and Management of Small Bowel Diverticular Hemorrhage: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases.

Chen YY, Chiu CT, Hsu CM, Chen TH, Chiu YC, Chu YC, Chang CW, Wang HP, Wu DC, Huang TY, Yen HH - Gastroenterol Res Pract (2015)

Bottom Line: Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study.Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%.In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan ; Endoscopy Center, Department of Gastroenterology, Changhua Christian Hospital, Changhua 50000, Taiwan.

ABSTRACT
Small bowel diverticulum is a rare cause of gastrointestinal bleeding. The diagnosis and treatment of small bowel diverticular hemorrhage is clinically challenging before the development of deep enteroscopy. In this multicenter study from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID), 608 patients underwent deep enteroscopy for obscure gastrointestinal bleeding during January 2004 and April 2010 from eight medical centers in Taiwan. Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study. Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%. In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy.

No MeSH data available.


Related in: MedlinePlus

Flow chart of patient management and outcome.
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fig1: Flow chart of patient management and outcome.

Mentions: During enteroscopic examination, 25% (12/48) of patients were found to have ulcers without bleeding associated with the diverticulum and the remaining (75%) patients were found to have active bleeding or stigmata of recent hemorrhage, that is, blood clots or protruding vessels. The patient management and outcome were summarized in Figure 1. Two patients were referred for surgery after diagnosis and 11 patients received conservative medical therapy, including parenteral nutrition and/or tranexamic acid therapy. Most of the patients (35/48) received endoscopic therapy as a first-line treatment to control bleeding. A single endoscopic procedure, such as argon plasma coagulation (n = −9), hemoclip (n = 7), or injection (n = 8), was performed in 68.57% (24/35) of patients and the remainder (11/35) received combined therapy. Initial hemostasis was achieved in 85.7% (30/35) and recurrent bleeding was observed in 20% (6/30) of these patients; recurrent bleeding occurred in 12.5% (6/48) during the 1-month follow-up period; and the overall bleeding-related mortality rate was 8.33% (4/48), including uncontrolled recurrent bleeding (n = 2), acute renal failure (n = 1), and multiple organ failure after angiography embolization (n = 1).


Enteroscopic Diagnosis and Management of Small Bowel Diverticular Hemorrhage: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases.

Chen YY, Chiu CT, Hsu CM, Chen TH, Chiu YC, Chu YC, Chang CW, Wang HP, Wu DC, Huang TY, Yen HH - Gastroenterol Res Pract (2015)

Flow chart of patient management and outcome.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4550765&req=5

fig1: Flow chart of patient management and outcome.
Mentions: During enteroscopic examination, 25% (12/48) of patients were found to have ulcers without bleeding associated with the diverticulum and the remaining (75%) patients were found to have active bleeding or stigmata of recent hemorrhage, that is, blood clots or protruding vessels. The patient management and outcome were summarized in Figure 1. Two patients were referred for surgery after diagnosis and 11 patients received conservative medical therapy, including parenteral nutrition and/or tranexamic acid therapy. Most of the patients (35/48) received endoscopic therapy as a first-line treatment to control bleeding. A single endoscopic procedure, such as argon plasma coagulation (n = −9), hemoclip (n = 7), or injection (n = 8), was performed in 68.57% (24/35) of patients and the remainder (11/35) received combined therapy. Initial hemostasis was achieved in 85.7% (30/35) and recurrent bleeding was observed in 20% (6/30) of these patients; recurrent bleeding occurred in 12.5% (6/48) during the 1-month follow-up period; and the overall bleeding-related mortality rate was 8.33% (4/48), including uncontrolled recurrent bleeding (n = 2), acute renal failure (n = 1), and multiple organ failure after angiography embolization (n = 1).

Bottom Line: Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study.Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%.In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan ; Endoscopy Center, Department of Gastroenterology, Changhua Christian Hospital, Changhua 50000, Taiwan.

ABSTRACT
Small bowel diverticulum is a rare cause of gastrointestinal bleeding. The diagnosis and treatment of small bowel diverticular hemorrhage is clinically challenging before the development of deep enteroscopy. In this multicenter study from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID), 608 patients underwent deep enteroscopy for obscure gastrointestinal bleeding during January 2004 and April 2010 from eight medical centers in Taiwan. Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study. Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%. In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy.

No MeSH data available.


Related in: MedlinePlus