Endoscopic hemostasis using covered metallic stent placement for uncontrolled post-endoscopic sphincterotomy bleeding
Endoscopic hemostasis using covered metallic stent placement for uncontrolled post-endoscopic sphincterotomy bleeding
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DOI：
10.1055/s-0030-1256126
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发表时间：
2011-04-01
期刊：
影响因子：
9.3
通讯作者：
Sofuni, A.
中科院分区：
文献类型：
--
作者：
Itoi, T.;Yasuda, I.;Sofuni, A.
内窥镜胆道括约肌切开术（EBS）后严重出血有时难以控制，导致需要侵入性干预。本研究的目的是回顾性评估内镜下使用有盖自膨胀金属支架（SEMSs）止血的可行性和有效性。11例胆管结石患者在一所大学附属医院和一所综合医院的4个内镜单元采用标准括约肌切开术进行了标准的EBS手术。单药或联合治疗均可通过球囊填塞、高渗生理盐水肾上腺素注射或唇内放置达到止血目的。当活动性出血无法控制时，在主要乳头上放置有盖的扫描电镜。在入院当天或次日（入院后6至35小时）进行急诊内窥镜检查。轻度出血6例（54.5%），中度出血5例（45.5%）。在乳头上放置一个直径10mm，长6cm的覆盖SEMS。放置后，完全止血。平均支架放置时间为8.2天（范围5-10天），所有病例均成功移除SEMS。尽管目前的研究存在样本量小和缺乏对照患者的局限性，但覆盖SEMS放置用于内镜止血可能对ebs后出血不受控制的选定患者有用。
Severe bleeding following endoscopic biliary sphincterotomy (EBS) can sometimes be difficult to manage, resulting in the need for an invasive intervention. The aim of this study was to retrospectively evaluate the feasibility and efficacy of endoscopic hemostasis using covered self-expandable metallic stents (SEMSs) for severe post-EBS bleeding. Eleven patients with bile duct stones underwent standard EBS using a standard sphincterotome-based technique at 4 endoscopic units of a university-affiliated hospital and a general hospital. Monotherapy or combined therapy were used to achieve hemostasis with either balloon tamponade, hypertonic saline epinephrine injection, or endoclip placement. When active bleeding could not be controlled, covered SEMSs were placed across the major papilla. Emergency endoscopy was performed on the day of admission or the subsequent day (ranging from 6 to 35 h after admission). Bleeding was classified as mild in 6 cases (54.5%) and moderate in 5 (45.5%). A covered SEMS 10 mm in diameter and 6 cm long was placed across the papilla. After placement, complete hemostasis was achieved. The mean duration of stent placement was 8.2 days (range 5-10 days), and the SEMS was successfully removed in all cases. Although the present study has the limitations of a small sample size and lack of control patients, covered SEMS placement for endoscopic hemostasis may be useful in selected patients with uncontrolled post-EBS bleeding.