Efficacy and safety of three minimally invasive endoscopic procedures for the treatment of internal hemorrhoids / 中华消化内镜杂志

In order to evaluate the safety and effectiveness of endoscopic hemorrhoids treatment, a retrospective analysis was conducted on data of 166 patients with grade I to Ⅲ hemorrhoids who underwent endoscopic treatment in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to June 2020 with complete follow-up data. There were 35 cases in the simple sclerotherapy group, 104 cases in the simple ligation group, and 27 cases in the ligation combined sclerotherapy group. The results showed that, no serious complications occurred in the 3 groups after surgery. In the simple ligation group and the ligation combined with sclerotherapy group, the incidence of postoperative anal pain [35.6% (37/104) and 33.3% (9/27), respectively,] and anal pendant distension [70.2% (73/104) and 70.4% (19/27), respectively] were higher, but symptoms could be tolerated or relieved after simple treatment. The satisfaction of patients in the 3 groups was all more than 90% before discharge, and the degree of operation acceptance was more than 95%. The effective rate of the 3 groups was above 90.0% at 3 months after surgery, At 12 months after surgery, the effective rate of the simple sclerotherapy group was the lowest [74.3% (26/35)], and the effective rate of the other two groups was still above 85.0%. In conclusion, minimally invasive treatment for internal hemorrhoids under endoscopy is safe and effective with effective improvement of symptoms, high postoperative satisfaction of patients and high degree of acceptance.

Efficacy of endoscopic ligation resection and endoscopic submucosal excavation for small gastrointestinal stromal tumors originating from muscularis propria / 中华消化内镜杂志

Clinical data of 43 patients who underwent endoscopic resection for gastrointestinal stromal tumors (GIST) of length ≤1.2 cm at the Digestive Endoscopy Center of the 909th Hospital from January 2016 to December 2018 were retrospectively analyzed. The patients were divided into the endoscopic ligation resection (ELR) group ( n=27) and the endoscopic submucosal excavation (ESE) group ( n=16). The general, perioperative and follow-up data of the two groups were compared. The results showed that there was no significant difference in the general data between the two groups. The operation time was 20.0 (18.0,25.0) min in the ELR group and 27.5 (23.0,37.5) min in the ESE group, showing significant difference ( U=92.5, P=0.001). The en bloc resection rates were 100.0% (27/27) in the ELR group and 81.3% (13/16) in the ESE group, showing significant difference ( P=0.045). The postoperative hospital stays were 3 (2,4) days in the ELR group and 5 (4,6) days in the ESE group, showing significant difference ( U=125.5, P=0.020). There was no significant difference in the intraoperative bleeding rate, intraoperative hemorrhage volume, intraoperative perforation rate, number of hemostatic clips or postoperative complications including hemorrhage, fever and peritonitis between the two groups ( P>0.05). During the follow-up, there was no recurrence or metastasis of GIST in both groups. ELR and ESE can be safe and effective for small GIST ≤1.2 cm in diameter. Compared with the ESE group, the operation time and postoperative hospital stay are shorter with higher en bloc resection rate in the ELR group.

Clinical Observation of Danning Tablets Combined with Endoscopic Ligation in the Treatment of Esophageal Varices in Patients with Nonalcoholic Fatty Liver Cirrhosis / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of Danning tablets combined with endoscopic ligation in the treatment of esophageal varices in patients with nonalcoholic fatty liver cirrhosis(NFLC). METHODS:A total of 70 NFLC patients with esophageal varices in our hospital during Sept. 2015-Sept. 2016 were divided into control group and observation group by simple random sampling method,with 35 cases in each group. Both groups received endoscopic ligation. Control group was given Somatostatin for injection with intravenous pump at the speed of 250 μg/h for 72 h after surgery,and Pantoprazole sodium enteric-coated capsules 40 mg,qd. Observation group was additionally given Danning tablets 1 g,tid,on the basis of control group. Both groups were given medicine for consecutive 4 weeks.The situation of ligation and clinical efficacies were observed in 2 groups,and the grading of esophageal varices before and after treatment,the occurrence of re-bleeding events and ADR were observed. RESULTS:The patients of 2 groups completed ligation successfully,there was no statistical significance in the times of ligation between 2 groups(P>0.05). Total response rate of observation group was 91.43%,which was significantly higher than 74.29% of control group,with statistical significance(P<0.05).Before treatment,there was no statistical significance in the grading of esophageal varices between 2 groups(P>0.05). One month and three months after treatment,the grading of esophageal varices in 2 groups were significantly better than before treatment,and observation group was significantly better than control group,with statistical significance(P<0.05). There was no statistical significance of 2 groups between 3 months after treatment and one month after treatment(P>0.05).Total incidence of re-bleeding events in observation group was 14.29% within 3-month follow-up,which was significantly lower than 40.00% of control group,with statistical significance(P<0.05). There was no statistical significance in the total incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Danning tablets combined with endoscopic ligation show significant therapeutic efficacy for esophageal varices of NFLC,significantly mitigate the degree of esophageal varices and reduce the incidence of re-bleeding without increasing the occurrence of ADR.

Manejo de epistaxis posterior en el Hospital Clínico de la Universidad de Chile entre los años 2013 y 2016 / Treatment of posterior epistaxis in the Clinical Hospital of the University of Chile between the years 2013 and 2016

Introducción: La epistaxis corresponde a una de las causas más frecuentes de consulta otorrinolaringológica en los servicios de urgencia. La epistaxis posterior es menos frecuente pero su presentación más severa. Existen varias alternativas terapéuticas, en las últimas décadas el manejo quirúrgico endoscópico de la arteria esfenopalatina (AEP) ha ido en aumento dado las ventajas en comodidad para el paciente y reducción de costos asociados. Objetivo: Revisar el manejo realizado en los cuadros de epistaxis posterior en el Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio descriptivo en el Servicio de Otorrinolaringología del HCUCh de pacientes que presentaron epistaxis posterior entre el año 2013 y 2016. Resultados: Se revisó un total de 33 casos. La edad promedio de los pacientes fue 61,6 años siendo las comorbilidades más frecuentes la hipertensión arterial (36,3%) y fibrilación auricular (18,1%). Se realizó tratamiento quirúrgico en 57,6% de los pacientes siendo el clipaje de AEP la intervención quirúrgica más frecuente. Discusión y conclusiones: Tanto el manejo tradicional como las técnicas quirúrgicas presentaron eficacia similar en la serie revisada.

Introduction: Epistaxis corresponds to one of the most frequent causes of otorhinolaryngological consultation in the emergency services. Posterior epistaxis is less frequent but more severe. There are several therapeutic alternatives, in recent decades the surgical endoscopic management of the sphenopalatine artery (AEP) has been increasing given the advantages in comfort for the patient and reduction of associated costs. Aim: To review the management of posterior epistaxis in the Clinical Hospital of the University of Chile (HCUCh). Material and method: Descriptive study in the Otorhinolaryngology Service of the HCUCh of patients who presented posterior epistaxis between the years 2013 and 2016. Results: A total of 33 cases were reviewed. The mean age of the patients was 61.6 years, with the most frequent comorbidities being hypertension (36.3%) and atrial fibrillation (18.1%). Surgical treatment was performed in 57.6% of the patients, with AEP clipping being the most frequent surgical intervention. Conclusion: Both traditional management and surgical techniques presented similar efficacy in the revised series.

The Efficacy and Safety of Endoscopic Esophageal Varix Ligation combined with Omeprazole and Octreotide in the Treatment of Esophageal Variceal Bleeding / 现代生物医学进展

Objective:To explore the efficacy and safety of endoscopic esophageal varix ligation (EVL) combined with omeprazole and octreotide in the treatment of esophageal variceal bleeding.Methods:127 patients with cirrhosis complicated with esophageal variceal hemorrhage diagnosed and treated in our hospital from May 2014 to May 2016 were divided into the study group and the control group.The control group was treated with omeprazole and octreotide on the basis of conventional therapy,while the study group was treated with endoscopic esophageal variceal ligation (EVL) on the basis of control group.The clinical efficacy,hospitalization condition,incidence of adverse reactions and rebleeding rate after treatment of the two groups were analyzed.Results:All the patients in the study group were successfully operated.In the control group,10 patients showed hematemesis and melena,among which 1 patient wastreated with surgery.After treatment,the c lini cal effi cacy of the study group was superi or to the control group,and the di fference was stati sti cally significant (P＜0.05).During the treatment period,the hemostasis time,blood transfusion time,hospital stay and hospitalization expenses of the study gronp were significantly lower than those of the control group (P＜0.05).In the study group and the control group,10 cases and 7 cases respectively had nausea and vomiting,esophageal foreign body sensation,dizziness,palpitations,pain,bloating,increased facces frequency,fever and other adverse reactions,and the incidence of increased faeces frequency of control group was significantly higher than that of the study group (P＜0.05),but the incidence of other adverse reactions and the total incidence showed no significant difference between two groups (P＞0.05).The rate of rebl eeding was si gni fi cantly lower in the study group at 0.5,1,3,6 and 12 months after treatment than those in the control group(P＜0.05).Conclusion:Endoscopic ligation combined with omeprazole and octreotide was effective in the treatment of esophageal variceal bleeding,which could be effective,rapid hemostasis,reduce the hospital stay,hospitalization cost and rebleeding rate with high safety.

Respuesta a la terapia combinada vs monoterapia con betabloqueantes en profilaxis primaria de sangrado variceal en pacientes con cirrosis hepática / Response to combined therapy vs beta blockers monotherapy in the primary prophylaxis of bleeding esophageal varices in cirrhotics

Esta investigación tuvo como objetivo comparar los resultados del propanolol combinado o no con ligadura endoscópica (LE) en la profilaxis primaria del sangrado variceal en pacientes que acudieron al Servicio de Gastroenterología del Hospital Universitario de Maracaibo, durante los meses de Enero a Octubre 2009. La investigación fue de tipo correlacional, prospectiva, longitudinal. La población estuvo conformada por 40 pacientes entre 18 y 75 años de edad con Cirrosis Hepática y varices esofágicas de tamaño mediano-grande con o sin signos rojos, sin antecedentes de hemorragia digestiva superior. Se seleccionaron al azar 2 grupos, el primero estuvo representado por 20 pacientes, quienes fueron sometidos a LE combinado con Propanolol y el segundo por 20 pacientes tratados sólo con Propanolol. Para la recolección de datos se diseñó un cuestionario basado en las variables, dimensiones e indicadores propuestos en la investigación. Se demostró que el propanolol como monoterapia es tan efectivo como combinado con LE en la profilaxis primaria del sangrado variceal.

This research was aim to relate the results propranolol combined or not with endoscopic ligation (LE) in the primary prophylaxis of variceal bleeding in the Gastroenterology Service, Hospital Universitario de Maracaibo, during the months of January to October 2009. A correlational, prospective, longitudinal type study. The population was 40 patients between 18 and 75 years old with liver cirrhosis and esophageal varices of large-medium size, with no history of upper gastrointestinal bleeding. They were two randomly selected samples, the first is represented by 20 patients who underwent LE combined with propranolol and the second 20 patients treated with propranolol alone. For data collection a questionnaire was designed based on the variables, dimensions and indicators proposed in the research. We demonstrated that monotherapy with propranolol is as effective as combined with LE in the primary prophylaxis of variceal bleeding.

Duodenal Variceal Bleeding Treated with a Combination of Endoscopic Ligation and Injection Sclerotherapy: Two Case Reports and a Review of the Korean Clinical Literature / 대한소화기내시경학회지

A duodenal varix is a rare cause of hemorrhage in patients with intrahepatic and extrahepatic portal hypertension. However, bleeding in these patients is serious and often life threatening. Treatments for duodenal variceal bleeding include endoscopic injection sclerotherapy, endoscopic ligation, surgical procedures and interventional radiology. We report two cases of duodenal variceal bleeding in a 53- year-old male patient and a 63-year-old female patient with liver cirrhosis that presented with hematemesis and melena. Emergency upper endoscopy examinations revealed the presence of large nodular varices with ruptured erosion on the top of the second portion of the duodenum. A combination of the use of endoscopic ligation and endoscopic injection sclerotherapy was performed and successful hemostasis and eradication of duodenal varices was possible in all cases. Another 19 cases of duodenal variceal bleeding that have been reported in the Korean clinical literature were reviewed.

Clinical course of esophageal varices treated with endoscopic variceal ligation / 대한내과학회지

BACKGROUND: Endoscopic variceal ligation (EVL) has been widely used to control acute variceal bleeding. However, eradication of varices with EVL is difficult and rebleeding following successful EVL is frequently problematic. Our aims were to assess the efficacy of EVL for treatment of acute variceal bleeding and to evaluate risk factors associated with rebleeding during follow-up period. METHODS: One-hundred and five patients were included, who had undergone EVL due to bleeding of esophageal varices. Retrospective analysis was performed about hemostatic success rate, rebleeding rate and risk factors for rebleeding. RESULTS: Hemostatic success rate was 84.8% (89/105). During follow-up period, eradication of varices was observed in 5.7% (6/105), downgrading in 44.8% (47/105), no change of grade in 35.2% (37/105), and progression of varices was observed in 3.8% (4/105). Mean number of sessions for eradication were 3.3 (range, 2 to 8). Rebleeding was observed in 55.2% (58/105), and rebleeding rate increased with lapse of time, as 24.5% after 3 months, and 37.1% in 6 months, and 50.7% in 12 months, respectively. Multivariate analysis for risk factors of rebleeding showed that number of sessions of variceal ligation was associated with significant reduction of rebleeding (p=0.01, OR 0.184). CONCLUSION: EVL was effective for hemostasis of acute variceal bleeding, but progression of varices and rebleeding episodes were common. Adequate follow-up evaluation is mandatory, and repeated variceal ligation is required for eradication of varices and secondary prevention of bleeding.

A case of bleeding duodenal varix treated by endoscopic band ligation / 대한내과학회지

The occurrence of duodenal varices is rare. They are often overlooked as a source of upper gastrointestinal bleeding in patients with portal hypertension. Experience in control of bleeding duodenal varices is limited. Endoscopic variceal ligation (EVL) is generally considered a safer alternative than endoscopic injection sclerotherapy for treatment of bleeding esophageal varices. Recently EVL has been described as a successful treatment for ruptured duodenal varices. We present a case of bleeding duodenal varices in a 46-year-old man with liver cirrhosis and cholangiocarcinoma who presented with melena. Emergency endoscopy revealed no esophagogastric varices, but several nodular varices were found in the second portion of the duodenum. A punctate ulcer overlying the varix with intermittent bleeding was observed. The hemorrhagic lesion was successfully treated by endoscopic ligation after failure of hemostasis with ethanolamine injection theapy. Endoscopic ligation may be a therapeutic choice to arrest active duodenal variceal bleeding.

A Successful Endoscopic Therapy for Uncontrolled Duodenal Varix after Transjugular Intrahepatic Portosystemic Shunt / 대한소화기내시경학회지

Duodenal varix is a rare site of bleeding in patient with portal hypertension and frequently causes massive bleeding. Treatment modalities are endoscopic sclerotherapy, endoscopic ligation, transjugular intrahepatic portosystemic shunt (TIPS), and shunt operation. A patient with duodenal varix was hemodynamically unstable and an emergent salvage transjugular intrahepatic portosystemic shunt was performed. In spite of TIPS procedure, varix bleeding was not controlled and endoscopic band ligation and endoscopic sclerotherapy were performed with successful hemostasis and eradication of duodenal varix.

A Dieulafoy's Lesion of the Rectum Treated by Endoscopic Band Ligation: A case report / 대한소화기내시경학회지

The Dieulafoy's lesion is an unusual cause of gastrointestinal hemorrhage that results from the erosion of abnormally large submucosal artery. The lesion is usually located in the stomach, although it may occur anywhere in the gastrointestinal tract. Lower GI bleeding from Dieulafoy- like lesion of rectum is very rare. We describe one patient with extragastric Dieulafoy's disease, in the rectum. Diagnosis was made by endoscopy. Recently, endoscopy is important in the treatment of Dieulafoy-like lesion of rectum including epinephrine injection and coagulation therapy. We treated with the endoscopic management using ligation technique. We report a case that the 65-year old women had a extragastric Dieulafoy's lesion on the rectum, treated by endoscopic ligation with O-ring.

Treatment of Bleeding Esophageal Varices with Endoscopic Variceal Ligation Plus Somatostatin / 中国药房

OBJECTIVE:To evaluate the short and long-term therapeutic effects of endoscopic variceal ligation(EVL) plus somatostatin on bleeding esophageal varices METHODS:64 patients with acute esophageal variceal bleeding due to portal hypertension underwent EVL,then the patients were divided into EVL group and EVL+somatostatin group RESULTS:The short-term hemostatic rates reached 93% in both groups There were significant differences in postoperative rebleeding rate and average interval of rebleeding between two groups(P

Endoscopic Ligation Therapy for Gastric Angiodysplasia / 대한소화기내시경학회지

Gastric angiodysplasia may be responsible for up to 2% to 6% of upper gastrointestinal bleeding. Moreover, gastric angiodysplasia may be particularly difficult to treat and is usually associated with a high rebleeding rate. Bleeding due to gastric angiodypsplasia is usually treated by various endoscopic approaches, including argon and Nd:YAG laser photocoagulation, monopolar or biopolar electrocoagulation, heater probe, or injection. Associated complications of these methods, however, such as perforation, acute bleeding during the procedure, or delayed massive hemorrhage have been reported. Recently a few reports have been suggested that endoscopic ligation therapy is a safe, effective treatment for gastric angiodysplasia. A 70-year-old man, who had undergone subtotal gastrectomy for perforation of a duodenal ulcer for 20 years, was admitted due to melena and dizziness persisting for 1 week. A gastroscopy revealed a single angiodysplasia with active bleeding just above the anastomotic site of the remnant stomach. Endoscopic ligation therapy was performed successfully and the bleeding stopped immediately after endoscopic ligation. Since then, no recurrence of bleeding has been reported to date.

2 Cases of Endoscopic Ligation Therapy of a Dieulafoy Ulcer / 대한소화기내시경학회지

A dieulafoy ulcer is rarely recognized but is not an uncommon cause of massive, recurrent and frequently fatal gastrointestinal bleeding resulting from the erosion of an unusually large submucosal artery. Although the lesion has been predominantly found in the proximal stomach, it has also been detected throughout the gastrointestinal tract. Diagnosis can be made by observation of protruding and eroded arteries with pulsatile bleeding, or through detection of an adherent thrombus using an endoscopy. In the past, surgical intervention was believed to be the best treatment, but currently, therapeutic endoscopy is more favored, due to its recent success in achieving permanent hemostasis. We experienced 2 cases of Dieulafoy's ulcer of the stomach. Endoscopic ligations using an O ring were performed successfully.

A Case of Endoscopically Removed Granular Cell Tumor of the Esophagus / 대한소화기내시경학회지

The first case report of granular cell tumor was by Abrikossoff in 1926, the tumor has been named with more than 20 different synonyms. It is found usually in the tongue, oral cavity, and the skin. It occurs rarely in the esophagus. Esophageal granular cell tumor is a benign lesion which can be diagnosed by endoscopic biopsy. Large symptomatic lesion can be removed by polypectomy. A 29-year-old female visited our hospital for intermittent epigastric pain and anterior chest discomfort. Endoscopy showed a 0.6 *0.4 cm whitish yellow nodule in the mid-esophagus, 25 cm from the incisor teeth. Endoscopic polypectomy was performed with "O"-type rubber band for endoscopic variceal ligation(EVL). A case of esophageal granular cell tumor conformed by S-100 protein stain is reported with the review of literature.

The Usefulness of Endoscopic O-ring Band Ligation in the Management of Mallory - Weiss Syndrome / 대한소화기내시경학회지

Mallory-Weiss syndrome is a laceration in the region of the gastroesophageal junction due to vomiting, retching, coughing preceding hematemesis in alcoholic patient. Bleeding from Malloly-Weise tears stop spontaneously without specific therapy in 80-90% of patient, but rebleeding occurs in 2 to 5% of patients. Thus most patients require only supportive care. Rarely endoscopic therapy or operative therapy may be required. We performed endoscopic mucosal ligation using intraluminal negative pressure with band ligation for uncontrolled Mallory-Weiss syndrome. In conclusion, Endoscopic O-ring band ligation in uncontrolled intractable Mallory-Weiss syndrome is safe and effective method, but its important that accurate endoscopic O-ring band ligation an bleeding site in laceration area. We experienced endoscopic O-ring band ligation in 6 cases of Mallory-Weiss syndrome.

Efficacy of endoscopic dense ligation on bleeding esophageal varices(EV) / 中华消化内镜杂志

Objective To evaluate the efficacy and complication of endoscopic dense ligation for bleeding esophageal varices(EV). Methods 128 cases of EV experienced varcies ligation, and 16～22 points(average 18.8 points) of the varices were ligated by using dense ligation, while only 5～6 points were ligated in common ligation (common method) for varices. All patients got one to two times of ligation therapy. Results In dense ligation group, the rate of prompt hemostasis was 96.9%, rate of elimination of EV was 92.2% with one therapy, and 96.9% with twice therapy, while the rate of bleeding was 0.8%. In common method the rates were 95.7%, 42.6%, 64.7% and 7.1% respectively. Between the two groups, the rate of elimination of EV and rebleeding had significant difference (P

Endoscopic Ligation of Large Gastric Varices Using a Detachable Snares and Rubber Bands / 대한소화기내시경학회지

Bleeding from gastric varices greater than 2cm in diameter represents a major limitation for endoscopic hemostasis. The endoscopic injection sclerotherapy (EIS) using conventional sclerosing agents is not satisfactory for the control of acute bleeding from gastric varices which have large diameter, fast blood flow and abundant collateral circulations. Endoscopic ligation using small rubber bands, known to be alternative to EIS, never obliterate large gastric varices greater than 2 cm in diameter. Obliteration therapy using Histoacryl (n-buty1-2-cyanoacrylate), known to be more satisfactory, has some drawback such as embolization. We per formed endoscopic ligation using detachable snares and rubber bands in 22 patients who had recently bleeding from gastric varices larger than 2 cm in diameter. For ligation of gastric varices larger than 2 cm in diameter, the detachable snares were used, and then for ligation of adjacent small gastric varices, rubber bands were used. In seven patients active bleedings were noted at initial endoscopy; 6 of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands, but one patient who was uncontrolled by it died from bleeding and multiple organ failure. In remaining 15 patients, there were no active bleeding but red color signs on large gastric varices; all of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands. Early rebleeding, fol lowing initial treatment, occurred in two patients (9.5%). So overall hemostatic rate of endoscopic ligation using the detachable snares and the rubber bands was 86.4% (19/22). Varices were nearly eradicated in 18 (85.7%) of the 21 survivors by ligation of 1-3 detachable snares (mean, l.3 snares) and 4-30 rubber bands (mean, 16,2 bands) in 2-6 sessions (mean, 3.2 sessions). During or after ligation, there were no serious complications, except transient epigastric pain or discomfort in 14.7% and fever in 1.3%. These results suggest that endoscopic ligation therapy with detachable snares and rubber bands is a safe and effective method for treatment of acute bleeding of gastric varices, especially gastric varices larger than 2 cm in diameter, which can not he controlled by conventional scleratherapy or variceal band ligation.

Endoscopic Ligation Therapy of Dieulafoy Ulcer / 대한소화기내시경학회지

Dieulafoy ulcer is an unusual cause of massive, recurrent and frequently fatal gastrointestinal hemorrhage that results from erosion of abnormally large submucosal artery. Although the lesion has been found throughout the gastrointestinal tract, it most commonly occurs in the proximal stomach. Diagnosis depends on the observation of protruding and eroded artery with pulsatile bleeding or adherent thrombus by endoscopy. Even during active bleeding, the endoseopic examination can be negative if intraluminal blood or clots obscure the source of bleeding. If the bleeding has stopped, the small mucosal lesion can be easily overlooked. Unlike peptic ulceration, there is no excavation of the mucosa. A 76-year-old man presented with massive hematemesis and melena. The patient had no previous history of peptic ulcer disease. He did not drink alcohol and use aspirin or NSAIDs. Physical examination revealed a pale, severely diaphoretic male with hypotension and melenic stools. He was found to have hemoglobin 4.0 g/dL and hematocrit 12.7%. We performed emergency endoscopy which showed a pulsatile and bleeding exposed artery without evidence of surrounding ulcerative lesion on the posterior wall of upper body of stomach. Endoscopic ligation using O ring of Stiegman-Goff endoscopic ligator kit was done successfully and the bleeding stopped immediately after ligation. Ten days after treatment, endoscopy showed artificial ulcerative lesion on previous ligated site and no evidence of bleeding. Another endoscopy four days later revealed healing ulcerative lesion. After improvement, the patient was discharged and rebleeding has not occurred to date.