Utility of Dual Red Imaging for Endoscopic Hemostasis of Gastric Ulcer Bleeding.

Dual red imaging (DRI; Red Dichromatic Imaging (RDI)) is a new type of image-enhanced endoscopy composed of two long wavelengths that together can visualize vessels in the deep submucosa of the gastrointestinal wall. We treated a case of gastric ulcer bleeding in which the bleeding point could be clearly visualized using DRI. A 71-year-old man who was taking warfarin for atrial fibrillation noticed tarry stool, entered a state of hypovolemic shock, and underwent emergency esophagogastroduodenoscopy. The procedure was performed with a GIF-Y0058 prototype endoscope (Olympus Co., Tokyo, Japan) equipped with a DRI mode. An ulcer with active bleeding was found in the upper portion of the stomach, but the massive volume of the bleeding made it difficult to identify the bleeding point using white light imaging (WLI). Upon switching to DRI mode by pushing a button on the endoscope, the bleeding point could be identified rapidly and precisely, as it appeared in a deeper yellow than the surrounding area. Complete hemostasis was thereupon achieved. This case demonstrates that the DRI mode may be useful for detecting bleeding points that are difficult to detect using WLI.

Changes of gastric ulcer bleeding in the metropolitan area of Japan.

BACKGROUND: The two main causes of gastric ulcer bleeding are Helicobacter pylori (H. pylori) infection and ulcerogenic medicines, although the number of cases caused by each may vary with age. In Japan, the rate of H. pylori infection has fallen over the last decade and the number of prescriptions for non-steroidal anti-inflammatory drugs (NSAIDs) and antithrombotic drugs is increasing as the population ages. Methods of treatment for gastric ulcer bleeding have advanced with the advent of hemostatic forceps and potassium-competitive acid blocker (P-CAB). Thus, causes and treatments for gastric ulcer bleeding have changed over the last decade. AIM: To examine the trends of gastric ulcer bleeding over 10 years in the metropolitan area of Japan. METHODS: This is a single-center retrospective study. A total of 564 patients were enrolled from inpatients admitted to our hospital with gastric ulcer bleeding between 2006 and 2016. Age, medication history, H. pylori infection, method of treatment, rate of rebleeding, and the length of hospitalization were analyzed. Factors associated with gastric ulcer bleeding were evaluated using Fisher's exact test, Pearson's Chi-squared test or Student's t-test as appropriate. The Jonckheere-Terpstra test was used to evaluate trends. A per-protocol analysis was used to examine the rate of H. pylori infection. RESULTS: There was a significant increase in the mean age over time (P < 0.01). The rate of H. pylori infection tended to decrease over the study period (P = 0.10), whereas the proportion of patients taking antithrombotic agents or NSAIDs tended to increase (P = 0.07). Over time, the use of NSAIDs and antithrombotic drugs increased with age. By contrast, the rate of H. pylori infection during the study period fell with age. H. pylori-induced ulcers accounted for the majority of cases in younger patients (< 70 years old); however, the rate decreased with age (P < 0.01). The method of treatment trend has changed significantly over time. The main method of endoscopic hemostasis has changed from clipping and injection to forceps coagulation (P < 0.01), and frequently prescribed medicines have changed from proton pump inhibitor to P-CAB (P < 0.01). The rate of rebleeding during the latter half of the study was significantly lower than that in the first half. CONCLUSION: These trends, gastric ulcers caused by ulcerogenic drugs were increasing with age and H. pylori-induced ulcers were more common in younger patients, were observed.

Osmotic demyelination syndrome caused by normal saline correction in a patient admitted for gastric ulcer bleeding.

A 61-year-old male had osmotic demyelination syndrome caused by rapid correction of gastric ulcer bleeding and vomiting related hyponatraemia with normal saline. It is rare to see severe hyponatraemia caused by gastric ulcer bleeding and vomiting. Hypokalaemia may be the determinant predisposing factor. There was no specific brain image finding until 17 days after the initial clinical presentation of this disease. Brain diffusion weighted MRI series did not help for the early diagnosis in this case. Outcome of this case may be more favourable if we corrected his hyponatraemia with half-saline or other hypotonic saline and close monitored serum sodium level, and relowered with dextrose water and desmopressin once we observed that the correction rate of hyponatraemia was beyond the recommended rate.

Acute myocardial infarction coincident with gastric ulcer bleeding following herbal medication-induced acute renal failure / 대한내과학회지

Acute renal failure, acute myocardial infarction (AMI), and gastric ulcer bleeding (GUB) are associated with high rates of morbidity and mortality, especially in older patients. The development of each of these conditions can be followed by the development of another; however, it is rare for these three conditions to develop concurrently. Here, we report the case of a 92-year-old man who was admitted because of generalized weakness that developed after the ingestion of nothing but functional foods, including herbal medications containing Glycyrrhiza and Aloe, for ten days. After admission, AMI and GUB developed approximately six hours apart. Conservative treatment was chosen for the bleeding ulcer because of the high procedural risk, and the use of antiplatelet agents and heparinization for treatment of the infarction were stopped. The patient remained hemodynamically stable following the administration of a statin, diuretics, and proton pump inhibitors. A healed scar at the site of the ulcer was confirmed three weeks later; however, postinfarct angina developed after the patient's last endoscopy. Percutaneous coronary intervention was successfully performed with two stents placed in the left anterior descending artery.

A Case of Severe Gastric Ulcer Bleeding after Exchange for Replacement Balloon Gastrostomy Tube in Percutaneous Endoscopic Gastrostomy / 대한소화기내시경학회지

PEG is a simple, safe and rapid method for the placement of feeding gastrostomy tube because of its low morbidity and mortality. Also, exchange of gastrostomy tube can be easily performed because several types of exchange tube, suich as replacement balloon gastrostomy tube are available. But, less has been known about complications of exchange tube. The authors experienced a case of severe gastric ulcer bleeding in seventy one years old male patient who had been suffered from melena after exchange of old PEG tube for replacement balloon gastrostomy tube. Gastroscopy showed bleeding from acute, large and deep ulcer on the body of stomach, and replacement tube tip directed to the center of ulcer. Bleeding was thought to be caused by gastric ulcer due to replacement balloon gastrostomy tube, After removal of tube and conservative management with H2 receptor antagonist, bleeding ceased

Clinical Application of Endoscopic Laser Therapy in Gastrointestinal Disese: Especially in early gastric cancer / 대한소화기내시경학회지

I tried the endoscopic laser therapy for the malignant and benign disease of the alimentary tract to evaluate efficacy in rejection of surgical treatment or inoperable state. I have experienced 16 cases of the laser therapy in my hospital from July 1990 to June 1991. The apparatus I used is the SLT contact Nd-YAG laser with the ceramic endoprobe of rounded or chisel or hollow type in each case. The irradiation was made at an output of 15-20 Watts within 1.5 seconds. Between the 2-4 weeks laser therapy, the treatment response was observed by rebiopsy, I treated 7 cases of early gastric cancer and post-laser follow-up study showed 70% negative for cancer cells by endoscopic biopsy. Failure of laser treatment was found in case of IIc type, Two cases of advanced gastric and I case of rectal cancer with severe obstruction were relieved by laser therapy. I also experienced 3 cases of esophageal or gastric polyp which were completely. resolved after irradiation. Besides, I could get hemostasis in 1 case of gastric ulcer bleeding with exposed vessels and 1 case of Mallory-Weiss syndrome. And a case of gastric bezoar was completely fragmentated after irradiation. As mentioned above, I achieved satisfactory results of 13 cases in 16 cases. Contact Nd - YAG laser treatment ean be applicated with excellent efficacy in any age, sex and severity of disease with or without complications and any site of lesions which can be reached within the endoscope. I suggest it is maybe highly promising medical technique in the future.