ABSTRACT
We propose this variant of the clip technique as a method that assist traction during endoscopic submucosal dissection (ESD): traction on the mucosa plane using an hemoclip carrying a surgical silk and three rubber bands, before the incision, to allow easier access to the submucosa space. We propose this variant with the intention of facilitating access to ESD quickly and safely for beginners.
Subject(s)
Endoscopic Mucosal Resection , Humans , Endoscopic Mucosal Resection/methods , Treatment Outcome , Dissection/methods , Mucous Membrane , Surgical InstrumentsSubject(s)
Humans , Male , Middle Aged , Endoscopic Mucosal Resection/methods , Rectal Neoplasms/surgery , Treatment OutcomeABSTRACT
BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but "Downhill Varices" (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications. CASE REPORT: A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass. DISCUSSION: DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS.
ABSTRACT
Introducción: la hemorragia digestiva alta (HDA) es una entidad común en gastroenterología, pero las Downhill varices (DHV) son una causa infrecuente de HDA, con diferente etiología de las varices esofágicas de tercio inferior y con diferentes implicaciones terapéuticas. Caso clínico: varón de 28 años de edad, con antecedentes de insuficiencia renal crónica sometido a hemodiálisis y síndrome de vena cava superior(SVCS) debido a múltiples sustituciones catéter, acude a urgencias por hematemesis secundaria a ruptura de una variz en tercio proximal de esófago, que inicialmente se trata con etanolamina. El estudio diagnóstico posterior demostró la circulación colateral secundaria al SVCS. No se pudo realizar terapia endoscópica o endovascular y el paciente finalmente se someterá a un bypass quirúrgico. Discusión: las DHV son una entidad infrecuente y la ligadura endoscópica con bandas se erige como el abordaje terapéutico apropiado para el evento hemorrágico. La terapia definitiva sigue siendo la de la causa del SVCS (AU)
Background: Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but Downhill Varices (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications. Case report: A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass. Discussion: DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS (AU)
Subject(s)
Humans , Male , Adult , Esophageal and Gastric Varices/blood , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/diagnosis , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/surgery , Endoscopy/methods , Angioplasty/instrumentation , Angioplasty/methods , Varicose Veins/blood , Varicose Veins/complications , Thrombosis/complications , Thrombosis/surgery , ThrombosisSubject(s)
Enbucrilate/adverse effects , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/therapy , Hemostasis, Endoscopic/adverse effects , Portal Vein , Sclerosing Solutions/adverse effects , Venous Thrombosis/etiology , Aged , Enbucrilate/therapeutic use , Female , Hemostasis, Endoscopic/methods , Humans , Portasystemic Shunt, Transjugular Intrahepatic , Sclerosing Solutions/therapeutic use , Venous Thrombosis/therapyABSTRACT
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