Endoscopic band ligation for treatment of bleeding dieulafoy's lesions in the upper gastrointestinal tract

Dieulafoy's lesion [DL] is an underdiagnosed cause of acute and/or recurrent gastrointestinal bleeding. This study was conducted to evaluate the efficacy and safety of endoscopic band ligation [EBL] in the treatment of patients with bleeding DL in the upper gastrointestinal tract. Out of 2380 patients who had emergency endoscopic examinations for upper GI bleeding, ten patients [8 were males and 2 were females] had DL and were treated by EBL. Mean age was 54.6 years. All patients presented with acute gastrointestinal bleeding [hematemesis, melena or both]. Emergency endoscopy and endoscopic therapy were performed in all patients using EBL. Initial hemostasis was achieved after a single banding session using one elastic band in 9 of the 10 patients [90%] with bleeding DL. The remaining patient [10%], with actively bleeding esophageal DL had recurrent bleeding 24 hours later which was successfully controlled by another banding session. In all patients [100%], no further bleeding developed during the outpatient follow-up [6 months]. No serious complications [deep ulcers or perforations] were observed in any of the treated patients. In conclusion, these results confirm the efficacy and safety of this new modality in the endoscopic management of a rare but life-threatening cause of upper gastrointestinal hemorrhage

Red cell morphology using phase contrast microscopy as a predictor for the site of haematuria in children

Fifty haematuric children were included in this study. The site of bleeding predicted by phase contrast microscopy was compared microscopy was compared with that accuratey decided by the performed extensive renal and urological investigations. The morphology results revealed a dysmorphic pattern in 40%, eumorphic in 40% and mixed in 20% of the cases. the patients with dysmorphism showed definite glomerular pathology; those with eumorphism had a non-glomerular pathology. However, in the group with mixed pattern where the site of bleeding could not be predicted by red cell morphology, different pathological patterns were reported. This study highly recommends phase contrast microscopy as a simple non-invasive and inexpensive technique that helps efficient prediction of the bleeding site in the majority of haematuric cases