ABSTRACT
BACKGROUND AND STUDY AIMS: Early reports of urgent colonoscopy in acute lower intestinal bleeding suggest a role for endoscopic therapy for bleeding colonic lesions, but scant data exist on bleeding diverticula. We report our experience with endoscopic hemostasis in acute diverticular bleeding. PATIENTS AND METHODS: Bleeding diverticula were identified on urgent diagnostic endoscopy in five patients with acute gastrointestinal bleeding, two in the duodenum, and three in the colon. All patients had co-morbid conditions preventing more conventional therapeutic approaches. The five cases are described, including the technique of endoscopic hemostasis and outcome. RESULTS: Endoscopic therapy using epinephrine injection, thermal cautery and/or laser therapy successfully induced hemostasis in all patients. One patient died of co-morbid illness during the hospital stay, while the remaining four patients had no recurrent bleeding over a mean follow-up period of 20.6 months. CONCLUSION: Endoscopic therapy of bleeding diverticula is technically possible when the culprit diverticulum can be identified. This therapeutic modality may have a place in debilitated patients in whom other more invasive procedures are contraindicated, but further experience is needed to establish its safety.
Subject(s)
Diverticulum, Colon/complications , Gastrointestinal Hemorrhage/therapy , Hemostasis, Endoscopic/methods , Acute Disease , Aged , Aged, 80 and over , Diverticulum, Colon/diagnosis , Endoscopy, Digestive System , Female , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Humans , Length of Stay , Male , Middle Aged , Treatment OutcomeSubject(s)
Fistula/etiology , Gastric Fistula/etiology , Heart Diseases/etiology , Peptic Ulcer/complications , Pericardium , Pneumopericardium/etiology , Aged , Aged, 80 and over , Endoscopy, Gastrointestinal , Female , Fistula/pathology , Gastric Fistula/pathology , Heart Diseases/pathology , Humans , Pericardium/pathology , Pneumopericardium/pathologySubject(s)
Brunner Glands/pathology , Duodenal Diseases/therapy , Endoscopy/methods , Gastrointestinal Hemorrhage/therapy , Hamartoma/therapy , Hemostasis, Endoscopic/methods , Adult , Combined Modality Therapy , Duodenal Diseases/complications , Duodenal Diseases/surgery , Follow-Up Studies , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Hamartoma/complications , Hamartoma/surgery , Humans , MaleABSTRACT
Complicated gastroesophageal reflux disease may be seen in a variety of congenital developmental syndromes, but progression of Barrett's metaplasia to adenocarcinoma is rare. We report the first case of esophageal adenocarcinoma in a young adult with Cornelia de Lange syndrome who had long-standing gastroesophageal reflux disease. We review the literature concerning Barrett's metaplasia in children and make recommendations for surveillance.