Endoscopic Therapy in the Management of Patients With Severe Rectal Bleeding Following Transrectal Ultrasound-Guided Prostate Biopsy: A Case-Based Systematic Review.
Endoscopic Therapy in the Management of Patients With Severe Rectal Bleeding Following Transrectal Ultrasound-Guided Prostate Biopsy: A Case-Based Systematic Review.
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DOI：
10.1177/23247096211013206
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发表时间：
2021-01
影响因子：
1.2
通讯作者：
Gaduputi VV
中科院分区：
文献类型：
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作者：
Malik A;Ishtiaq R;Goraya MHN;Inayat F;Gaduputi VV
直肠出血是经直肠超声引导前列腺活检的已知并发症。它通常是温和的，自发解决。然而，在这种情况下也很少发生危及生命的大出血，这可能是一个治疗难题。我们在此描述一例患者在经直肠超声引导下前列腺活检后发生严重间歇性下消化道出血。传统的填塞方法未能控制出血。随后，一个紧急的软乙状结肠镜检查显示直肠前壁隆起与活检穿刺作为可能的出血源。在出血部位成功应用Endoclip，实现永久止血。患者顺利恢复并出院。虽然内镜夹闭术在胃肠道内镜检查中的应用已被广泛报道，但其在这组患者中的应用仍然非常罕见。据我们所知，该病例仅为第三例前列腺活检术后单纯行内镜夹闭术治疗直肠大出血的病例。此外，我们系统地回顾了已发表的医学文献，以评估旨在管理这一重要并发症的内镜技术。这篇文章说明，内镜治疗可能是一种有效的，非侵入性的方法来处理严重的活检后直肠出血。因此，应提倡及时咨询胃肠病服务。
Rectal bleeding is a known complication of transrectal ultrasound-guided prostate biopsy. It is usually mild and resolves spontaneously. However, massive life-threatening hemorrhage can also rarely occur in this setting, potentially presenting a therapeutic conundrum. We hereby delineate the case of a patient who experienced severe intermittent lower gastrointestinal bleeding following a transrectal ultrasound-guided prostate biopsy. Traditional tamponade methods failed to control the hemorrhage. Subsequently, an urgent flexible sigmoidoscopy revealed an anterior rectal wall prominence with biopsy punctures as the possible source of bleeding. Endoclip was successfully applied at the bleeding site, achieving permanent hemostasis. The patient had an uneventful recovery and was discharged from the hospital. While the use of endoclipping has been widely reported in gastrointestinal endoscopy, its application remains exceedingly rare in this group of patients. To our knowledge, this case represents only the third report of endoclipping alone to treat massive rectal bleeding follwing a prostate biopsy procedure. In addition, we systematically review published medical literature to evaluate endoscopic techniques aimed at managing this important complication. This article illustrates that endoscopic therapy may present an efficient, noninvasive method to deal with severe post-biopsy rectal hemorrhage. Therefore, prompt consultation with the gastroenterology service should be advocated.