Treatment of bleeding colonic diverticula by endoscopic band ligation: an in-vivo and ex-vivo pilot study.
Treatment of bleeding colonic diverticula by endoscopic band ligation: an in-vivo and ex-vivo pilot study.
复制标题
内镜束带结扎治疗结肠憩室出血：一项体内和离体试点研究。
DOI：
10.1055/s-2003-42611
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发表时间：
2003
期刊：
影响因子：
9.3
通讯作者：
P. Kelsey
中科院分区：
文献类型：
--
作者：
J. Farrell;F. Graeme;P. Kelsey
背景和研究目的
血管造影和手术治疗是治疗持续性憩室出血的标准。由于对并发症的担忧以及外科医生和介入放射科医生对严重下消化道出血的广泛管理，使用肾上腺素注射、多极电烙术和放置Endoclip的结肠镜干预尚未获得广泛接受。在体内和离体两种情况下评价了结肠镜带结扎术控制憩室出血的效用。
患者和方法
对手术切除标本和活动性出血的结肠憩室患者进行内镜下憩室套扎术。
结果
在体内研究中，4例患者通过内镜下套扎术完全控制了活动性憩室出血。在2例病例中，在外翻和带状憩室上观察到可见血管。手术时间范围为45至140分钟。4例患者的住院总时间分别为2、6、14和35天。住院时间长（> 7天）与非胃肠道合并症相关。结扎带无急性并发症。在12个月的随访期内，所有患者均未发生再出血或需要手术。在离体研究中，9个手术标本中有5个（1个右侧结肠和4个左侧结肠）成功翻转并捆扎了11个憩室。在所有"带状"节段中识别出粘膜。11个结扎的憩室中有10个显示血管或粘膜下组织的证据。在11个"带状"节段中的3个节段中存在浆膜下脂肪，并且没有一个离体结扎的憩室包含固有肌层或浆膜参与。没有穿孔的证据。
结论
体内和体外数据均表明，内镜下套扎术可能是治疗活动性出血性结肠憩室的安全有效的方法。
BACKGROUND AND STUDY AIMS
Angiographic and surgical therapy are standards of care for persistent diverticular bleeding. Colonoscopic intervention using epinephrine injection, multipolar electrocautery, and placement of an Endoclip has not gained widespread acceptance due to concerns about complications,and the widespread management of severe lower gastrointestinal bleeding by surgeons and interventional radiologists. The utility of colonoscopic band ligation for control of diverticular bleeding was evaluated both in vivo and ex vivo.
PATIENTS AND METHODS
Endoscopic band ligation of diverticula was performed on surgical resection specimens and in patients with actively bleeding colonic diverticula.
RESULTS
In the in-vivo study, active diverticular bleeding was completely controlled in four patients by endoscopic band ligation. In two cases, a visible vessel was seen on the everted and banded diverticulum. Procedure time ranged from 45 to 140 min. The total lengths of hospital stays for the four patients were 2, 6, 14, and 35 days. The long hospital stays (> 7 days)were associated with non-gastrointestinal co-morbidity. There were no acute complications of band ligation. No rebleeding or need for surgery occurred during a follow-up period of 12 months in any of the patients. In the ex-vivo study, 11 diverticula were successfully everted and banded in five of nine surgical specimens (one right colon and four left colons). Mucosa was identified in all of the "banded" segments. Ten of 11 ligated diverticula revealed evidence of blood vessels or submucosal tissue. The presence of subserosal fat was suggested in three of the 11 "banded" segments, and none of the ex-vivo ligated diverticula contained muscularis propria or serosal involvement. There was no evidence of perforation.
CONCLUSIONS
Both in-vivo and ex-vivo data suggest that endoscopic band ligation may be a safe and effective therapy for actively bleeding colonic diverticula.