A new therapy for refractory gastric cancer bleeding: endoscopic ultrasound-guided lauromacrogol injection
A new therapy for refractory gastric cancer bleeding: endoscopic ultrasound-guided lauromacrogol injection
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难治性胃癌出血新疗法：超声内镜引导聚桂醇注射液
DOI：
10.1055/a-1398-5196
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发表时间：
2021
期刊：
影响因子：
9.3
通讯作者：
Hou Xiaohua
中科院分区：
文献类型：
--
作者：
Han Chaoqun;Ling Xin;Liu Jun;Ding Zhen;Hou Xiaohua
一位71岁的男性因残留胃癌伴肝转移而住院治疗顽固性消化道出血（图1）。他在过去的30天内有三次呕血或黑便发作。由于临床成功率低且再出血量高，无法切除的胃癌出血的传统内镜治疗具有挑战性[1]。在与患者及其家属仔细讨论后，决定使用内镜超声（EUS）引导下注射聚桂醇进行治疗。再次内镜检查显示残胃吻合口持续活动性出血（图2）。使用EUS辅助彩色多普勒成像（EUS视频1）识别出起源于粘膜下层并延伸至粘膜的血管。使用22号针头（Echo 3-22; Cook Endoscopy，温斯顿-塞勒姆，北卡罗来纳州，美国）进行EUS引导的聚桂醇注射。此外，彩色多普勒成像证实治疗后无血流（视频1）。注射后立即进行内窥镜检查，证实没有出血（图3）。患者随访超过6个月，未再发生胃肠道出血。术中或术后未记录不良事件或并发症。EUS引导下治疗非静脉曲张性上消化道出血的疗效已被描述。已发表的系列研究显示，Roux-en-Y胃旁路术后Dieulafoy病变、胰腺/胃十二指肠动脉假性动脉瘤、胃肠道间质瘤、壶腹周围肿瘤、十二指肠溃疡和难治性边缘溃疡的治疗成功率为88%-100%[2-4]。据我们所知，EUS引导下聚桂醇注射治疗难治性胃癌出血在此背景下尚未报道。
A 71-year-old man was admitted for intractable gastrointestinal bleeding because of residual gastric cancer with liver metastasis (▶ Fig. 1). He presented having had three episodes of hematemesis or melena in the previous 30 days. Conventional endoscopic management for bleeding of unresectable gastric cancer is challenging because of the low clinical success rate and high amount of rebleeding [1]. After careful discussion with the patient and his family, treatment using endoscopic ultrasound(EUS)-guided lauromacrogol injection was decided. Repeat endoscopy revealed persistent active bleeding from the anastomosis of the residual stomach (▶ Fig. 2). A vessel originating from the submucosa and extending into the mucosa was identified using EUS-aided color Doppler imaging (▶ Video 1). EUS-guided lauromacrogol injection was performed using a 22-gauge needle (Echo 3–22; Cook Endoscopy, Winston-Salem, NC, USA). Moreover, color Doppler imaging confirmed the absence of blood flow after therapy (▶ Video 1). Endoscopy immediately after the injection confirmed the absence of bleeding (▶ Fig. 3). The patient was followed for more than 6 months without further episodes of gastrointestinal bleeding. No adverse events or complications were recorded during or after the procedures. The efficacy of EUS-guided therapy of nonvariceal upper gastrointestinal bleeding has been described. Series have been published with success rates of 88%–100% for the treatment of Dieulafoy’s lesions, pancreatic/gastroduodenal artery pseudoaneurysms, gastrointestinal stromal tumors, periampullary tumors, duodenal ulcers, and intractable marginal ulcers after Roux-en-Y gastric bypass [2–4]. To our knowledge, EUS-guided lauromacrogol injection for the treatment of refractory gastric cancer bleeding has not been reported in this setting.