ABSTRACT
This is the first report about the endoscopic removal of hemangiomas in the gastrointestinal tract using the double-balloon enteroscopic technique. We report on a 16-year-old female patient with a 10-year history of chronic anemia due to recurrent gastrointestinal bleeding. Besides permanent iron substitution, up to 3 blood transfusions per week are necessary. At birth a blue rubber-bleb nevus syndrome was diagnosed, with blue angiomatous lesions preferring her skin and digestive tract. In the 8 years before admittance numerous conventional endoscopic procedures and one intraoperative endoscopy with laser coagulation of many cavernous hemangiomas were performed. In our department the successful treatment of 150 hemangiomas with argon plasma coagulation or polypectomy in combination with double-balloon enteroscopy and conventional endoscopy was achieved without complications.
Subject(s)
Catheterization/methods , Endoscopy, Gastrointestinal/methods , Gastrointestinal Neoplasms/surgery , Hemangioma/surgery , Laser Therapy/methods , Nevus, Blue/surgery , Skin Neoplasms/surgery , Adolescent , Combined Modality Therapy , Female , Gastrointestinal Neoplasms/pathology , Humans , Nevus, Blue/pathology , Skin Neoplasms/pathology , Syndrome , Treatment OutcomeSubject(s)
Adenoma/pathology , Colonic Polyps/pathology , Colorectal Neoplasms/pathology , Adenoma/diagnosis , Adenoma/surgery , Colonic Polyps/diagnosis , Colonic Polyps/surgery , Colonoscopy , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/surgery , Humans , Lymph Node Excision , Lymphatic Metastasis , Risk FactorsABSTRACT
The guide wire, an important requisite for the placement of endoscopic transpapillary biliary prostheses, should combine two, normally incompatible, properties: a high degree of flexibility for atraumatic passage through irregular or "bent" stenoses, and a high degree of stiffness, to prevent sidewise deviation during advancement of the prosthesis. These opposing, formerly incompatible, properties are combined in a new type of guide wire, known as the Varioguide. With the aid of a tension controller, the stiffness of the Varioguide can be varied steplessly. In 88.2% of 68 patients with stenosis of the bile duct we succeeded in placing a transpapillary endoprosthesis with the Varioguide. In 13 cases in which a previous attempt with the conventional guide wire was unsuccessful, placement of the endoprosthesis was successfully accomplished with the Varioguide; the reverse was true in only a single patient. In the case of very narrow, rigid high stenoses, in which placement of a transpapillary endoprosthesis is especially difficult, the Varioguide has proved highly suitable (stenoses of the bile duct bifurcation).
