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Original Articles
Effect of antithrombotic therapies on small bowel bleeding: an European multicenter retrospective study
Lucia Scaramella, Stefania Chetcuti Zammit, Reena Sidhu, Maurizio Vecchi, Gian Eugenio Tontini, Nicoletta Nandi, Matilde Topa, Luca Elli
Clin Endosc 2025;58(1):102-111.   Published online December 2, 2024
DOI: https://doi.org/10.5946/ce.2024.073
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Small bowel bleeding (SBB) is the main indication for videocapsule endoscopy (VCE); the diagnostic yield (DY) could be influenced by antithrombotic therapies. We explored the effects of these therapies on SBB.
Methods
Consecutive patients from two centers (Milan, Italy and Sheffield, UK) who underwent VCE between March 2001 and July 2020 were considered. Demographic data, clinical parameters, drug therapy, and technical characteristics of the procedure were collected. VCE findings and DY were evaluated.
Results
In total, 957 patients (1,052 VCEs) underwent VCE for SBB (DY 50.6%, no retention); 27 patients (27 VCEs) received direct oral anticoagulants, 87 (88 VCEs) received other anticoagulants, 115 (135 VCEs) received antiplatelet therapy, 198 (218 VCEs) received monotherapy, and 31 (32 VCEs) received combined therapy. There were no differences in the completion rate, findings, and DYs between each subgroup or between monotherapy and combined therapy. The overt bleeding rate was similar in all groups, even when comparing antithrombotic users versus those not on therapy (p=0.59) or monotherapy versus combined therapy (p=0.34).
Conclusions
VCE is safe and has a high clinical impact on SBB. Antithrombotic therapies did not affect DY or overt bleeding rate and, consequently, can be considered safe in terms of SBB risk.

Citations

Citations to this article as recorded by  
  • Antithrombotic and management of small bowel bleeding – time to throw caution into the wind?
    Lucia Scaramella, Agostino Cosenza, Cristina Romero-Mascarell, Luca Elli
    Current Opinion in Gastroenterology.2026; 42(3): 146.     CrossRef
  • Recent technological advances in video capsule endoscopy: a comprehensive review
    Minjee Kim, Hyun Joo Jang
    Clinical Endoscopy.2026; 59(2): 182.     CrossRef
  • Small bowel pathology – diet, pill or buzz?
    Reena Sidhu
    Current Opinion in Gastroenterology.2026; 42(3): 143.     CrossRef
  • Do all antithrombotic agents have a similar impact on small bowel bleeding?
    Chung Hyun Tae, Ki-Nam Shim
    Clinical Endoscopy.2025; 58(1): 80.     CrossRef
  • 4,538 View
  • 149 Download
  • 4 Web of Science
  • 4 Crossref
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Efficacy of hemostasis by gastroduodenal covered metal stent placement for hemorrhagic duodenal stenosis due to pancreatobiliary cancer invasion: a retrospective study
Yasunari Sakamoto, Taku Sakamoto, Akihiro Ohba, Mitsuhito Sasaki, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Yutaka Saito, Yasuaki Arai, Takuji Okusaka
Clin Endosc 2024;57(5):628-636.   Published online June 14, 2024
DOI: https://doi.org/10.5946/ce.2023.155
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Advanced pancreatic and biliary tract cancers can invade the duodenum and cause duodenal hemorrhagic stenosis. This study aimed to evaluate the efficacy of covered self-expandable metal stents in the treatment of cancer-related duodenal hemorrhage with stenosis.
Methods
Between January 2014 and December 2016, metal stents were placed in 51 patients with duodenal stenosis. Among these patients, a self-expandable covered metal stent was endoscopically placed in 10 patients with hemorrhagic duodenal stenosis caused by pancreatobiliary cancer progression. We retrospectively analyzed the therapeutic efficacy of the stents by evaluating the technical and clinical success rates based on successful stent placement, degree of oral intake, hemostasis, stent patency, and overall survival.
Results
The technical and clinical success rates were 100%. All 10 patients achieved a gastric outlet obstruction scoring system score of three within two weeks after the procedure and had no recurrence of melena. The median stent patency duration and overall survival after stent placement were 52 days (range, 20–220 days) and 66.5 days (range, 31–220 days), respectively.
Conclusions
Endoscopic placement of a covered metal stent for hemorrhagic duodenal stenosis associated with pancreatic or biliary tract cancer resulted in duodenal hemostasis, recanalization, and improved quality of life.

Citations

Citations to this article as recorded by  
  • Clinical significance of peritoneal lavage cytology in duodenal cancer
    Yuya Miura, Katsuhisa Ohgi, Ryo Ashida, Yoshiyasu Kato, Shimpei Otsuka, Hideyuki Dei, Katsuhiko Uesaka, Teiichi Sugiura
    Surgery.2025; 181: 109256.     CrossRef
  • Clinical effect of percutaneous hepatic puncture biliary drainage combined with metal stent implantation in the treatment of malignant obstructive jaundice
    Shoulin Zhang, Shaopeng Huang, Zheng Xing, Youwen Song, Fujian Yuan
    BMC Surgery.2025;[Epub]     CrossRef
  • 5,726 View
  • 279 Download
  • 2 Web of Science
  • 2 Crossref
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Clinical outcomes of nonvariceal upper gastrointestinal bleeding in nonagenarians and octogenarians: a comparative nationwide analysis
Khaled Elfert, James Love, Esraa Elromisy, Fouad Jaber, Suresh Nayudu, Sammy Ho, Michel Kahaleh
Clin Endosc 2024;57(3):342-349.   Published online February 7, 2024
DOI: https://doi.org/10.5946/ce.2023.130
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Nonagenarians will purportedly account for 10% of the United States population by 2050. However, no studies have assessed the outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) in this age group.
Methods
The National Inpatient Sample database between 2016 and 2020 was used to compare the clinical outcomes of NVUGIB in nonagenarians and octogenarians and evaluate predictors of mortality and the use of esophagogastroduodenoscopy (EGD).
Results
Nonagenarians had higher in-hospital mortality than that of octogenarians (4% vs. 3%, p<0.001). EGD utilization (30% vs. 48%, p<0.001) and blood transfusion (27% vs. 40%, p<0.001) was significantly lower in nonagenarians. Multivariate logistic regression analysis revealed that nonagenarians with NVUGIB had higher odds of mortality (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3–1.7) and lower odds of EGD utilization (OR, 0.86; 95% CI, 0.83–0.89) than those of octogenarians.
Conclusions
Nonagenarians admitted with NVUGIB have a higher mortality risk than that of octogenarians. EGD is used significantly in managing NVUGIB among nonagenarians; however, its utilization is comparatively lower than in octogenarians. More studies are needed to assess predictors of poor outcomes and the indications of EGD in this growing population.

Citations

Citations to this article as recorded by  
  • Risk of 30-day all-cause mortality in octogenarians with non-variceal upper gastrointestinal bleeding: a multinational analysis
    Do Han Kim, Jose A. Porres, Donghyun Ko, Denisa Costea, Sharon I. Narvaez, Luis M. Nieto, Frank J. Lukens, Pedro Palacios Argueta, Ben M. W. Illigens, Tiago L. Cerqueira, Paul T. Kröner
    European Geriatric Medicine.2026;[Epub]     CrossRef
  • Predictors of In-Hospital Mortality in Helicobacter pylori–Negative, Non-Variceal Upper Gastrointestinal Bleeding: A Retrospective Cohort Study
    Giselle Padilla Gutiérrez, Gregorio Jurado Delgado, Alex Domínguez-Vargas, Natalia Jurado Rua, Leonardo Brochado Fontalvo, Henry González-Torres
    Clinical and Experimental Gastroenterology.2026; Volume 19: 1.     CrossRef
  • Evaluating the Performance of Four Risk Assessment Scores in Nonvariceal Upper Gastrointestinal Bleeding
    Omer Kheir, Mohammed Ghamdi, Sheikha Dossary, Anwar B Alotaibi, Elrasheed M Elsabani, Hanin Fahad, Mona Alfaifi
    Cureus.2025;[Epub]     CrossRef
  • 6,663 View
  • 79 Download
  • 2 Web of Science
  • 3 Crossref
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Novel upper gastrointestinal bleeding sensor capsule: a first human feasibility and safety trial
Lukas Bajer, Marvin Ryou, Christopher C. Thompson, Pavel Drastich
Clin Endosc 2024;57(2):203-208.   Published online January 17, 2024
DOI: https://doi.org/10.5946/ce.2023.111
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Upper gastrointestinal bleeding (UGIB) is the most common GI condition requiring hospitalization, and can be diagnosed by direct visualization. The present study aimed to evaluate the safety and feasibility of using the PillSense system (EnteraSense Ltd.), a novel diagnostic tool designed for the rapid in vivo detection of UGIB, in human volunteers.
Methods
In the present study, 10 volunteers swallowed a PillSense capsule, followed by 2 servings of an autologous blood preparation. Participants were monitored for capsule passage, overall tolerability of the procedure, and adverse events.
Results
The procedure was completed per the protocol established in the present study in 9/10 cases. In 9 of the subjects, after capsule ingestion, the device indicated the absence of blood with sensor output values of 1. After the ingestion of the first blood mixture, the sensor outputs of all devices increased from 2.8 to 4, indicating that each camera detected blood. The sensor output remained within that range after the ingestion of the second mixture; however, in one case, the baseline capsule signal was positive, because of a preexisting condition. The passage of the capsule was verified in all patients, and no adverse events were reported.
Conclusions
The first trial of the PillSense system in human subjects demonstrated the feasibility, safety, and tolerability of utilizing this product as a novel, noninvasive, and easy-to-use triage tool for the diagnosis of patients suspected of having UGIB.

Citations

Citations to this article as recorded by  
  • Advances in implantable capsule robots for monitoring and treatment of gastrointestinal diseases
    Xiaofeng Wang, Hao Xu, Yanlong Ren, Ying Yuan, Fei Deng, Wei Gao, Zheng Lou, Xian-Tao Song, Hao Guo, Wei Han, Lili Wang
    Materials Science and Engineering: R: Reports.2025; 163: 100943.     CrossRef
  • Could a bleeding-sensor device be established as a new paradigm for detecting upper gastrointestinal bleeding before performing endoscopy?
    Sun Gyo Lim
    Clinical Endoscopy.2024; 57(2): 191.     CrossRef
  • Approaches of wearable and implantable biosensor towards of developing in precision medicine
    Elham Ghazizadeh, Zahra Naseri, Hans-Peter Deigner, Hossein Rahimi, Zeynep Altintas
    Frontiers in Medicine.2024;[Epub]     CrossRef
  • 6,309 View
  • 207 Download
  • 3 Web of Science
  • 3 Crossref
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Review
Endoscopic management of postoperative bleeding
Sung Hyeok Ryou, Ki Bae Bang
Clin Endosc 2023;56(6):706-715.   Published online November 2, 2023
DOI: https://doi.org/10.5946/ce.2023.028
AbstractAbstract PDFPubReaderePub
Postoperative gastrointestinal bleeding is a rare but serious complication that can lead to prolonged hospitalization and significant morbidity and mortality. It can be managed by reoperation, endoscopy, or radiological intervention. Although reoperation carries risks, particularly in critically ill postoperative patients, minimally invasive interventions, such as endoscopy or radiological intervention, confer advantages. Endoscopy allows localization of the bleeding focus and hemostatic management at the same time. Although there have been concerns regarding the potential risk of creating an anastomotic disruption or perforation during early postoperative endoscopy, endoscopic management has become more popular over time. However, there is currently no consensus on the best endoscopic management for postoperative gastrointestinal bleeding because most practices are based on retrospective case series. Furthermore, there is a wide range of individual complexities in anatomical and clinical settings after surgery. This review focused on the safety and effectiveness of endoscopic management in various surgical settings.

Citations

Citations to this article as recorded by  
  • Multidisciplinary management of a patient with vesicosigmoid fistula and multisystem diseases undergoing stoma reversal: a case report
    Jian Yang, Li Zhang, Ke Zeng
    BMC Surgery.2026;[Epub]     CrossRef
  • Gastrointestinal dysfunction after brain injury: Mechanisms and the role of the brain-gut axis
    Xia Zhao, Wei Zhang, Ying Zhang, Xing-An Liu
    World Journal of Gastroenterology.2026;[Epub]     CrossRef
  • Splenic Artery Pseudoaneurysm Causing Delayed Hematemesis After Total Gastrectomy With D2 Lymphadenectomy
    Aliki Vaia Rompou, Kleanthi C Ampntin, Ilias Vourlitis, Andreas Nikolaos Dafnis, Giorgos Gkeneralis, Dimitris P Korkolis
    Cureus.2026;[Epub]     CrossRef
  • Letter to the editor on “early postoperative endoscopy for predicting anastomotic leakage after minimally invasive esophagectomy: A large-volume retrospective study”
    Judith Sánchez-Zavaleta, Doyler Cubas-García
    Surgery.2025; 180: 108890.     CrossRef
  • Evaluating the efficacy of a novel hemostatic powder compared with traditional treatments in nonvariceal upper GI bleeding: a multicenter, randomized, noninferiority study
    Da Hyun Jung, Jun Chul Park, Joon Sung Kim, Moon Won Lee, Hyuk Lee, Gwang Ha Kim
    Gastrointestinal Endoscopy.2025; 101(4): 792.     CrossRef
  • Gastrointestinale Endoskopie im postoperativen Komplikationsmanagement
    Marcus Kantowski, Gabriel Alexander Salg
    Allgemein- und Viszeralchirurgie up2date.2025; 19(01): 53.     CrossRef
  • The impact of ERAS-based nursing interventions on postoperative complication management and prognosis in early gastrointestinal tumor endoscopic resection: a prospective randomized controlled study
    Yun Shen, Yu Xi, Li Gu Xian Ru, Huayu Liu
    Langenbeck's Archives of Surgery.2025;[Epub]     CrossRef
  • A comprehensive review of the types and management of stapling failures in colorectal surgery
    Sameh Hany Emile, Justin Dourado, Ebram Salama, Marylise Boutros, Steven D. Wexner
    Surgery.2025; 188: 109720.     CrossRef
  • Case Report: Intestinal Obstruction in a Patient on Antiplatelet Therapy
    Dr. Mohammed Elamin Elsirag, Dr. Amina Ibrahim Alyagoub, Dr. Elfatih Elsiddig Hagelamin, Nadir Nasraldin Abbas
    International Journal of Advanced Medical Sciences and Technology.2025; 6(1): 1.     CrossRef
  • 17,201 View
  • 292 Download
  • 6 Web of Science
  • 9 Crossref
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Original Articles
Preclinical study of a novel ingestible bleeding sensor for upper gastrointestinal bleeding
Kimberly F. Schuster, Christopher C. Thompson, Marvin Ryou
Clin Endosc 2024;57(1):73-81.   Published online May 31, 2023
DOI: https://doi.org/10.5946/ce.2022.293
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that necessitates early identification and intervention and is associated with substantial morbidity, mortality, and socioeconomic burden. However, several diagnostic challenges remain regarding risk stratification and the optimal timing of endoscopy. The PillSense System is a noninvasive device developed to detect blood in patients with UGIB in real time. This study aimed to assess the safety and performance characteristics of PillSense using a simulated bleeding model.
Methods
A preclinical study was performed using an in vivo porcine model (14 animals). Fourteen PillSense capsules were endoscopically placed in the stomach and blood was injected into the stomach to simulate bleeding. The safety and sensitivity of blood detection and pill excretion were also investigated.
Results
All the sensors successfully detected the presence or absence of blood. The minimum threshold was 9% blood concentration, with additional detection of increasing concentrations of up to 22.5% blood. All the sensors passed naturally through the gastrointestinal tract.
Conclusions
This study demonstrated the ability of the PillSense System sensor to detect UGIB across a wide range of blood concentrations. This ingestible device detects UGIB in real time and has the potential to be an effective tool to supplement the current standard of care. These favorable results will be further investigated in future clinical studies.

Citations

Citations to this article as recorded by  
  • Clinical impact and cost-effectiveness of a novel bedside ingestible optical sensor for detection of upper GI bleeding
    Monica Saumoy, Andrew Storm, Seth Buller, Nikhil Thiruvengadam
    The American Journal of Emergency Medicine.2026; 99: 497.     CrossRef
  • Ingestible electrochemical sensors: Emerging tools for gastrointestinal disease detection and monitoring
    Zhaodong Wang
    International Journal of Electrochemical Science.2025; 20(3): 100952.     CrossRef
  • An ingestible capsule for luminance-based diagnosis of mesenteric ischemia
    J. Chen, A. Alexiev, A. Sergnese, N. Fabian, A. Pettinari, Y. Cai, V. Perepelook, K. Schmidt, A. Hayward, A. Guevara, B. Laidlaw, I. Moon, B. Markowitz, I. Ballinger, Z. Yang, C. Rosen, N. Shalabi, S. Owyang, G. Traverso
    Science Robotics.2025;[Epub]     CrossRef
  • Miniaturized Capsule System Toward Real‐Time Electrochemical Detection of H2S in the Gastrointestinal Tract
    Justin M. Stine, Katie L. Ruland, Luke A. Beardslee, Joshua A. Levy, Hossein Abianeh, Santiago Botasini, Pankaj J. Pasricha, Reza Ghodssi
    Advanced Healthcare Materials.2024;[Epub]     CrossRef
  • 7,248 View
  • 190 Download
  • 5 Web of Science
  • 4 Crossref
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Comparison of conventional and new endoscopic band ligation devices for colonic diverticular bleeding
Ayaka Takasu, Takashi Ikeya, Yasutoshi Shiratori
Clin Endosc 2022;55(3):408-416.   Published online February 18, 2022
DOI: https://doi.org/10.5946/ce.2021.200
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic band ligation (EBL) is used to treat colonic diverticular bleeding (CDB). An endoscopic variceal ligation device for esophageal varices is used as a conventional EBL device (C-EBL). A new EBL device (N-EBL) was developed by Sumitomo Bakelite Co. in August 2018. We aimed to evaluate the clinical outcomes of N-EBL compared with those of C-EBL.
Methods
Seventy-nine patients who underwent EBL for CDB at St. Luke’s International Hospital, Japan, between 2017 and 2020 were included in this retrospective study. Patients were divided into the C-EBL and N-EBL groups. Their clinical outcomes, including achieving initial hemostasis, early rebleeding, procedure time, and EBL-associated adverse events, were evaluated.
Results
Of the 79 patients, 36 (45.6%) were in the C-EBL group and 43 (54.4%) were in the N-EBL group. The rate of achieving initial hemostasis was 100% in the C-EBL group and 93.0% in the N-EBL group. No significant difference was noted in the early rebleeding rate between the groups (p=0.24). The N-EBL group achieved a shorter median EBL procedure time than the C-EBL group (18.2 minutes vs. 14.2 minutes, p=0.02). No adverse events were observed in either group.
Conclusions
The N-EBL device is safe and useful and may reduce EBL procedure time.

Citations

Citations to this article as recorded by  
  • Clinical utility of a novel double-band endoscopic band ligation device for consecutive ligation in the management of diverticular bleeding
    Sayo Daidoji, Yugo Suzuki, Daisuke Kikuchi, Shu Hoteya
    VideoGIE.2026; 11(1): 21.     CrossRef
  • Endoscopic therapies for colonic diverticular bleeding: a systematic review and meta-analysis
    Gilmara Coelho Meine, Paula Santo, Lucas Monteiro Delgado, Gregory Thomas Brennan
    Surgical Endoscopy.2026; 40(2): 902.     CrossRef
  • Advances in endoscopic management of colonic diverticular bleeding
    Yasutoshi Shiratori, Syed Matthew Kodilinye, Ahmed E. Salem
    Current Opinion in Gastroenterology.2024; 40(5): 363.     CrossRef
  • Endoscopic Hemostasis and Antithrombotic Management
    Jamie Bering, Mashal J. Batheja, Neena S. Abraham
    Gastroenterology Clinics of North America.2024; 53(4): 573.     CrossRef
  • Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline
    Neil Sengupta, Joseph D. Feuerstein, Vipul Jairath, Amandeep K. Shergill, Lisa L. Strate, Robert J. Wong, David Wan
    American Journal of Gastroenterology.2023; 118(2): 208.     CrossRef
  • Effective endoscopic band ligation for diverticular perforation with a refractory pelvic abscess
    Koichi Soga, Atsushi Majima
    Clinical Endoscopy.2023; 56(2): 252.     CrossRef
  • A new band ligation device to treat colonic diverticular bleeding
    Yunho Jung
    Clinical Endoscopy.2022; 55(3): 367.     CrossRef
  • 7,612 View
  • 283 Download
  • 6 Web of Science
  • 7 Crossref
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Case Reports
Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report
Christophe Riquoir, Luis Antonio Díaz, David Chiliquinga, Roberto Candia, Fernando Pimentel, Alex Arenas
Clin Endosc 2021;54(5):754-758.   Published online May 25, 2021
DOI: https://doi.org/10.5946/ce.2021.060
AbstractAbstract PDFPubReaderePub
The Roux-en-Y gastric bypass is one of the most extensive surgical treatments for obesity. The treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass is complex due to the difficulty of accessing the excluded gastric antrum and duodenal bulb. There is no consensus regarding the management of this complication. While various techniques have been described to access the biliopancreatic limb, double-balloon enteroscopy is the most commonly used. If double-balloon enteroscopy is unavailable, a pediatric colonoscope may be used as an alternative; however, its use in such cases has not been described. We report the case of a 50-year-old male patient who underwent gastric bypass 13 years ago and was admitted for a second episode of upper gastrointestinal bleeding. The initial approach using upper endoscopy, colonoscopy, and abdominal computed tomography angiography did not reveal the cause of gastrointestinal hemorrhage; therefore, an endoscopic study of the biliopancreatic limb was performed using a pediatric colonoscope. A Forrest Ib ulcer was found in the duodenal bulb, and endoscopic therapy was administered. The evolution was found to be satisfactory.

Citations

Citations to this article as recorded by  
  • Endoscopic Ultrasound-Guided Gastric Remnant Access for Massive Upper Gastrointestinal Bleeding in Roux-en-Y Anatomy
    Soyoun J. Pak, Jessica E. Basso, Jerome C. Edelson
    ACG Case Reports Journal.2026;[Epub]     CrossRef
  • Abdominal apoplexy: a rare complication following Roux-en-Y gastric bypass
    Stephanie Alexander, Trent Cross
    International Surgery Journal.2025;[Epub]     CrossRef
  • Mapping the Landscape of Marginal Ulcers After One Anastomosis Gastric Bypass: Incidence, Regional Trends, and Treatment Insights from a Systematic Review and Meta-analysis
    Shahab Shahabi Shahmiri, Arash Mehraz, Kimia Jazi, Kimia Vakili, Ali Esparham, Mohammad Kermansaravi
    Obesity Surgery.2025; 35(11): 4824.     CrossRef
  • Endoscopic management of postoperative bleeding
    Sung Hyeok Ryou, Ki Bae Bang
    Clinical Endoscopy.2023; 56(6): 706.     CrossRef
  • 6,867 View
  • 101 Download
  • 3 Web of Science
  • 4 Crossref
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Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report
Epifanio Silvino do Monte Junior, Marcos Eduardo Lera dos Santos, Igor Braga Ribeiro, Gustavo de Oliveira Luz, Elisa Ryoka Baba, Bruno Salomão Hirsch, Mateus Pereira Funari, Eduardo Guimarães Hourneaux de Moura
Clin Endosc 2020;53(6):746-749.   Published online November 19, 2020
DOI: https://doi.org/10.5946/ce.2020.180
AbstractAbstract PDFPubReaderePub
The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.

Citations

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  • COVID-19 associated mucormycosis and their therapeutics
    Bhaswati Chatterjee, Suman S. Thakur
    Heliyon.2026; 12(4): e44661.     CrossRef
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    SAIMSARA Journal.2026;[Epub]     CrossRef
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    Sevag Hamamah, Nupur Savalia, Faizi Hai
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    Benoît Henry, Alain Lefevre Utile, Stephane Jaureguiberry, Adela Angoulvant
    Journal of Fungi.2025; 11(4): 298.     CrossRef
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    Ali Moheb-Alian, Ali Akbari, Saghi Nooraei, Howra Bahrulolum, Zoheir Mohammadian Farsani, Negin Mokhtari, Mozhdeh Sadat Ebadi, Arezoo Mohammadian Farsani, Seyedmoein Khatami, Mohammadmahdi Esmaeili, Zahra Keykhaee, Mohammad Hossein Heydargoy, Zahra Rafiei
    Infectious Disorders - Drug Targets.2025;[Epub]     CrossRef
  • Uncovering the Predisposing Factors of Mucormycosis: Insights from Systematic Review
    Ramya Ravindhiran, Kumarappan Chidambaram, Anandalakshmi Subramanian, Suresh Velayutham, Mohankumar Ramar, Kavitha Dhandapani
    Indian Journal of Microbiology.2025;[Epub]     CrossRef
  • Gastrointestinal mucormycosis associated with leptospirosis: should we be concerned during major floods?
    Mariane Taborda, Juliana Possatto Fernandes Takahashi, Jessica de Brito Ferreira Nascimento, Julia Ferreira Mari, Vítor Falcão de Oliveira, Adriana Satie Gonçalves Kono Magri, Ana Catharina de Seixas Santos Nastri, Marcello Mihailenko Chaves Magri
    Revista do Instituto de Medicina Tropical de São Paulo.2025;[Epub]     CrossRef
  • Mucormycosis as a complication of COVID-19: connection with immunodeficiency states, features of the course and prevention
    O.V. Bobrova, N.H. Mikhanovska, N.H. Tsukor
    Karazin Journal of Immunology.2025; (15): 8.     CrossRef
  • The potential for rapid antigen testing for mucormycosis in the context of COVID-19
    Christopher R. Thornton
    Expert Review of Molecular Diagnostics.2024; 24(3): 161.     CrossRef
  • A New Proposed Combined CT and MRI Staging System for Covid-19-Associated Rhino-Orbito-Cerebral Fungal Infection: A Multi-center Study with Pathological Correlation
    Noha Yahia Ebaid, Haitham Foda, Doaa Khedr Mohamed Khedr, Ahmed Ebeed, Mahmoud Ahmed Ebada, Rabab Mohamed Abdelhay, Ali Awad, Amany Abd Al Badea, Basma Hamed Ibrahim, Emad Hassan Emara
    Academic Radiology.2024; 31(3): 1055.     CrossRef
  • Development of a Machine Learning Model to Predict Risk of Development of COVID-19-Associated Mucormycosis
    Rajashri Patil, Sahjid Mukhida, Jyoti Ajagunde, Uzair Khan, Sameena Khan, Nageswari Gandham, Chanda Vyawhare, Nikunja K Das, Shahzad Mirza
    Future Microbiology.2024; 19(4): 297.     CrossRef
  • COVID-19 Second Wave with Mucormycosis, a Deadly Combination: A Systemic Review
    Neetu Jain, Seema Bhadauria
    Biomedical and Biotechnology Research Journal.2024; 8(1): 13.     CrossRef
  • Mucorales: A systematic review to inform the World Health Organization priority list of fungal pathogens
    C Orla Morrissey, Hannah Yejin Kim, Katherine Garnham, Aiken Dao, Arunaloke Chakrabarti, John R Perfect, Ana Alastruey-Izquierdo, Thomas S Harrison, Felix Bongomin, Marcelo Galas, Siswanto Siswanto, Daniel Argaw Dagne, Felipe Roitberg, Valeria Gigante, Ha
    Medical Mycology.2024;[Epub]     CrossRef
  • Fungal Infection in Upper Gastrointestinal Tract
    Ayoung Lee, Sung Woo Jung, Jung Mogg Kim
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    BMJ Case Reports.2021; 14(7): e244096.     CrossRef
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    Arun Kumar Agnihotri, Monika Vij, Okezie I. Aruoma, Vipul D Yagnik, Theeshan Bahorun, Maria Elena Villamil, Godfred A. Menezes, Vineet Gupta
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    Iyer Mahalaxmi, Kaavya Jayaramayya, Dhivya Venkatesan, Mohana Devi Subramaniam, Kaviyarasi Renu, Padmavathi Vijayakumar, Arul Narayanasamy, Abilash Valsala Gopalakrishnan, Nachimuthu Senthil Kumar, Palanisamy Sivaprakash, Krothapalli R.S. Sambasiva Rao, B
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    Marcelo Mochate FLOR, Igor Braga RIBEIRO, Diogo Turiani Hourneaux DE MOURA, Sérgio Barbosa MARQUES, Wanderley Marques BERNARDO, Eduardo Guimarães Hourneaux DE MOURA
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    Yudhyavir Singh, Venkata Ganesh, Shailendra Kumar, Nishant Patel, Richa Aggarwala, Kapil Dev Soni, Anjan Trikha
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    Deepak Garg, Valliappan Muthu, Inderpaul Singh Sehgal, Raja Ramachandran, Harsimran Kaur, Ashish Bhalla, Goverdhan D. Puri, Arunaloke Chakrabarti, Ritesh Agarwal
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  • COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras
    Elsa Yolanda Palou, María Auxiliadora Ramos, Emec Cherenfant, Adoni Duarte, Itzel Carolina Fuentes-Barahona, Lysien I. Zambrano, Fausto Muñoz-Lara, Sandra Aracely Montoya-Ramirez, Alex Francisco Cardona-Ortiz, Jorge Alberto Valle-Reconco, Juan J. Monteneg
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  • A rare case of knee joint mucormycosis with pathological fracture after COVID-19 infection
    Sergiu Andrei Iordache, Adrian Cursaru, Bogdan Şerban, Mihnea Ioan Gabriel Popa
    Romanian Journal of Orthopaedic Surgery and Traumatology.2021; 4(1): 9.     CrossRef
  • Epidemiology and Pathophysiology of COVID-19-Associated Mucormycosis: India Versus the Rest of the World
    Valliappan Muthu, Shivaprakash M. Rudramurthy, Arunaloke Chakrabarti, Ritesh Agarwal
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    Ahmet Dilek, Resat Ozaras, Sevket Ozkaya, Mustafa Sunbul, Elif Itir Sen, Hakan Leblebicioglu
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  • COVID-19 and mucormycosis in Latin America – An emerging concern
    Alfonso J. Rodriguez-Morales, Carlos S. Mamani-García, Janeth N. Nuñez-Lupaca, Darwin A. León-Figueroa, Mely Olarte-Durand, Robinson A. Yrene-Cubas, Diana M. Ticona, Sebastian Abanto-Urbano
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  • Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients
    Maryam Roudbary, Sunil Kumar, Awanish Kumar, Lucia Černáková, Fatemeh Nikoomanesh, Célia F. Rodrigues
    Journal of Fungi.2021; 7(9): 720.     CrossRef
  • A case report of rhino-facial mucormycosis in a non-diabetic patient with COVID-19: a systematic review of literature and current update
    Faezeh Mohammadi, Milad Badri, Shapoor Safari, Nima Hemmat
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  • Mucormycosis: A manifestation in COVID-19 infection
    Abhishek Sharma, Gulnaz Bano, Abdul Malik
    Indian Journal of Pharmacy and Pharmacology.2021; 8(3): 189.     CrossRef
  • A Review of Coronavirus Disease Covid-19
    Swapnali Zore
    International Journal of Advanced Research in Science, Communication and Technology.2021; : 104.     CrossRef
  • COVID-19 Associated Mucormycosis: A Systematic Review from Diagnostic Challenges to Management
    Farah Yasmin, Hala Najeeb, Aisha Naeem, Kartik Dapke, Rachana Phadke, Muhammad Sohaib Asghar, Syed Muhammad Ismail Shah, Domenico De Berardis, Irfan Ullah
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  • COVID-19-Associated Mucormycosis (CAM): An Updated Evidence Mapping
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    International Journal of Environmental Research and Public Health.2021; 18(19): 10340.     CrossRef
  • Rhino-orbital Mucormycosis as a complication of severe COVID-19 pneumonia
    Mohammed A. Alamin, Mohammed Abdulgayoom, Sushil Niraula, Elabbass Abdelmahmuod, Ashraf O. Ahmed, Mohammed I. Danjuma
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    Abanoub Riad, Alshaimaa Ahmed Shabaan, Julien Issa, Sally Ibrahim, Hatem Amer, Yossef Mansy, Islam Kassem, Amira Bisher Kassem, Hans-Peter Howaldt, Miloslav Klugar, Sameh Attia
    Journal of Fungi.2021; 7(10): 837.     CrossRef
  • Sinoorbital Mucormycosis Associated with Corticosteroid Therapy in COVID-19 Infection
    Zeinab Mehrabi, Maryam Salimi, Kianoush Niknam, Farzaneh Mohammadi, Hesan Jelodari Mamaghani, Mohammad Reza Sasani, Mohammad Javad Ashraf, Amirhossein Salimi, Mohammad Hassan Zahedroozegar, Zohreh Erfani, Huban Atilla
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  • Mucormycosis infection in severe COVID‐19 patient with multiple underlying health conditions
    Zahra Heydarifard, Moslem Safaei, Sevrin Zadheidar, Soroush Ehsan, Nazanin Zahra Shafiei‐Jandaghi
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  • Invasive Fungal Infections Complicating COVID-19: A Narrative Review
    Giacomo Casalini, Andrea Giacomelli, Annalisa Ridolfo, Cristina Gervasoni, Spinello Antinori
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  • Coronavirus Disease 2019–Associated Invasive Fungal Infection
    John W Baddley, George R Thompson, Sharon C -A Chen, P Lewis White, Melissa D Johnson, M Hong Nguyen, Ilan S Schwartz, Andrej Spec, Luis Ostrosky-Zeichner, Brendan R Jackson, Thomas F Patterson, Peter G Pappas
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    Jugal Sutradhar, Bapi Ray Sarkar
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  • Salix spp. Bark Hot Water Extracts Show Antiviral, Antibacterial, and Antioxidant Activities—The Bioactive Properties of 16 Clones
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  • Mucormycosis – resurgence of a deadly opportunist during COVID-19 pandemic: Four case reports
    Shalini Upadhyay, Tanisha Bharara, Manisha Khandait, Ankit Chawdhry, Bharat Bhushan Sharma
    World Journal of Clinical Cases.2021; 9(36): 11338.     CrossRef
  • Mucormycosis following COVID19: clinical case and literature review
    Sofya N. Khostelidi, V.A. Zaytsev, E.V. Pelikh, E.V. Yashina, O.N. Rodionova, T.S. Bogomolova, Yu.L. Avdeenko, Nikolay N. Klimko
    Clinical Microbiology and Antimicrobial Chemotherapy.2021; 23(3): 255.     CrossRef
  • COVID-19 associated mucormycosis (CAM)
    Manas Pustake, Purushottam Giri, Mohammad Arfat Ganiyani
    Journal of Family Medicine and Primary Care.2021; 10(12): 4619.     CrossRef
  • Incidence, cumulative mortality and factors affecting the outcome of COVID-19-associated mucormycosis from Western India
    Archana Ajay Vare, Snehalata Yellambkar, Asma Farheen, Varsha Nandedkar, Swati S Bhombe, Rachana Shah
    Indian Journal of Ophthalmology.2021; 69(12): 3678.     CrossRef
  • 16,483 View
  • 284 Download
  • 118 Web of Science
  • 134 Crossref
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Original Articles
Utility of the Gel Immersion Method for Treating Massive Colonic Diverticular Bleeding
Kazuki Yamamoto, Yasutoshi Shiratori, Takashi Ikeya
Clin Endosc 2021;54(2):256-260.   Published online August 11, 2020
DOI: https://doi.org/10.5946/ce.2020.081
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: In Asia, right-sided diverticular bleeding is more common than that of the left side. It often causes massive bleeding and difficulties in identifying the stigmata of recent hemorrhage (SRH) of colonic diverticular bleeding (CDB). This case series demonstrates the efficacy of the gel immersion method using OS-1 Jelly (Otsuka Pharmaceuticals Factory, Tokushima, Japan) in patients with CDB.
Methods
This retrospective case series analyzed data of patients with CDB who underwent the gel immersion method from April 2016 to February 2020 at St. Luke’s International Hospital, Japan. All patients diagnosed with CDB who underwent the gel immersion method were included. We collected data on the site of bleeding, identification of SRH, and efficacy of the method from the electronic medical records.
Results
A total of 9 patients (including 7 with right-sided CDB) underwent gel immersion method and were included in this study. SRH were successfully found in 66.7% (6/9) of patients. Moreover, effective hemostasis was achieved in 85.7% (6/7) of patients with right-sided CDB. There were no adverse events.
Conclusions
The gel immersion method was found to be effective, especially for massive right-sided CDB.

Citations

Citations to this article as recorded by  
  • Gel immersion in endoscopy: Exploring potential applications
    Hiroki Sato, Hidemasa Kawabata, Mikihiro Fujiya
    World Journal of Gastroenterology.2025;[Epub]     CrossRef
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    Hirosato Doi, Masanori Takahashi, Keita Sasajima, Takehiro Yoshii, Ryo Chinzei
    Endoscopy International Open.2025;[Epub]     CrossRef
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    V. N. Ektov, A. V. Fedorov, M. A. Khodorkovsky
    Koloproktologia.2025; 24(4): 209.     CrossRef
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    Yasutoshi Shiratori, Syed Matthew Kodilinye, Ahmed E. Salem
    Current Opinion in Gastroenterology.2024; 40(5): 363.     CrossRef
  • Successful direct clipping of the bleeding source of a colonic diverticular hemorrhage using the “long-hood gel-filling” method
    Satoshi Abiko, Koji Hirata, Kazuharu Suzuki, Kenji Kinoshita, Kazuteru Hatanaka, Yoshiya Yamamoto, Hirohito Naruse
    Endoscopy.2023; 55(S 01): E606.     CrossRef
  • Utility of under-gel endoscopic mucosal resection with partial submucosal injection for a laterally spreading tumor
    Kazuki Yamamoto, Naoki Kanomata, Takashi Ikeya
    Endoscopy.2022; 54(03): E88.     CrossRef
  • Localizing spontaneously hemostatic colonic diverticular bleeding using VISCOCLEAR gel: A case report
    Daisuke Suto, Masashi Yoshida, Takaaki Otake, Eiichiro Ichiishi, Kiichi Sato, Yosuke Osawa, Hirotoshi Ebinuma, Hironori Odaira, Yutaka Suzuki, Yutaka Kohgo
    Annals of Medicine & Surgery.2022;[Epub]     CrossRef
  • Gel Immersion Endoscopic Mucosal Resection (EMR) for Superficial Nonampullary Duodenal Epithelial Tumors May Reduce Procedure Time Compared with Underwater EMR (with Video)
    Takeshi Yamashina, Masaaki Shimatani, Yu Takahashi, Masahiro Takeo, Natsuko Saito, Hironao Matsumoto, Takeshi Kasai, Masataka Kano, Kimi Sumimoto, Toshiyuki Mitsuyama, Hiroyuki Marusawa, Akiyoshi Nishio, Takafumi Yuba, Toshihito Seki, Makoto Naganuma, Tat
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  • Digital compression for hemostasis in acute hemorrhagic rectal ulcer: a report of 4 cases and review of the literature
    Takeshi Okamoto, Ayaka Takasu, Takaaki Yoshimoto, Kazuki Yamamoto, Yasutoshi Shiratori, Takashi Ikeya, Katsuyuki Fukuda
    Clinical Journal of Gastroenterology.2021; 14(3): 796.     CrossRef
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    Shuichi Miyamoto, Kazuharu Suzuki, Kenji Kinoshita
    Digestive Endoscopy.2021;[Epub]     CrossRef
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    Tomonori Yano, Atsushi Ohata, Yuji Hiraki, Makoto Tanaka, Satoshi Shinozaki, Alan Kawarai Lefor, Hironori Yamamoto
    Endoscopy International Open.2021; 09(06): E918.     CrossRef
  • Gel immersion endoscopy: Innovation in securing the visual field – Clinical experience with 265 consecutive procedures
    Tomonori Yano, Takahito Takezawa, Kousei Hashimoto, Ayako Ohmori, Satoshi Shinozaki, Manabu Nagayama, Hirotsugu Sakamoto, Yoshimasa Miura, Yoshikazu Hayashi, Keijiro Sunada, Alan Kawarai Lefor, Hironori Yamamoto
    Endoscopy International Open.2021; 09(07): E1123.     CrossRef
  • 8,450 View
  • 201 Download
  • 13 Web of Science
  • 12 Crossref
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Efficacy of the Envelope Method in Applying Polyglycolic Acid Sheets to Post-Endoscopic Submucosal Dissection Ulcers in Living Pigs
Hiroya Sakaguchi, Toshitatsu Takao, Yoshitaka Takegawa, Yuki Koga, Kazunori Yamanaka, Masataka Sagata, Shinwa Tanaka, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama
Clin Endosc 2021;54(1):64-72.   Published online July 16, 2020
DOI: https://doi.org/10.5946/ce.2020.014
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD) ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This study assessed the usefulness of the envelope-based delivery system with and against gravity in living pigs.
Methods
PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelope methods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors were compared.
Results
With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm2 and 0.32 (0.18–0.52) min/cm2 with the conventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm2 and 0.50 (0.39–0.58) min/cm2 (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional group had insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similar between the groups.
Conclusions
The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriately both with and against gravity in living pigs.

Citations

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  • Konjac glucomannan/sodium alginate/ε-poly-l-lysine hydrogel promotes esophageal and colonic wound healing
    Tianyu Zhou, Zhaoxue Liu, Lei Xu, Xinli Mao, Haifeng Jin, Yangyang Xiong, Guangwu Chen, Yong Lv, Li Cen, Chunren Wang, Yu Zhang, Kexin Ye, Qien Shen, Jiaming Zhou, Bin Lv, Jianying Dai, Chaohui Yu, Zhe Shen
    International Journal of Biological Macromolecules.2025; 306: 141146.     CrossRef
  • Endoscopic sealing hemostasis with polyglycolic acid sheet and fibrin glue as a novel endoscopic hemostatic technique: a report of three cases
    Kai Korekawa, Atsushi Kunimitsu
    Clinical Journal of Gastroenterology.2024; 17(4): 626.     CrossRef
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    Congzhi Liu, Guochun Yan, Jie Gao, Haixin Guo, Qidong Hou
    Catalysts.2024; 14(12): 903.     CrossRef
  • Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy
    Kei Matsumoto, Shinwa Tanaka, Takashi Toyonaga, Nobuaki Ikezawa, Mari Nishio, Masanao Uraoka, Tomoatsu Yoshihara, Hiroya Sakaguchi, Hirofumi Abe, Tetsuya Yoshizaki, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Hiroshi Yokozaki, Yuzo Kodama
    Clinical Endoscopy.2022; 55(1): 86.     CrossRef
  • The importance of pH adjustment for preventing fibrin glue dissolution in the stomach: an in vitro study
    Yoshitaka Takegawa, Toshitatsu Takao, Hiroya Sakaguchi, Tatsuya Nakai, Kazuhiro Takeo, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama
    Scientific Reports.2022;[Epub]     CrossRef
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    Meng Li, Haifeng Jin, Changpei Shi, Bin Lyu, Xiao Ying, Yuan Shi
    Frontiers in Pharmacology.2021;[Epub]     CrossRef
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  • 140 Download
  • 7 Web of Science
  • 6 Crossref
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Endoscopic Findings in Patients Under the Age of 40 Years with Hematochezia in Singapore
Man Hon Tang, Fung Joon Foo, Chee Yung Ng
Clin Endosc 2020;53(4):466-470.   Published online June 18, 2020
DOI: https://doi.org/10.5946/ce.2019.029
AbstractAbstract PDFPubReaderePub
Background
/Aims: Sigmoidoscopy is performed in most medical centers to evaluate the distal colons of young adults presenting with hematochezia who are at risk of developing proximal lesions. Colonoscopies offer more complete evaluations but are associated with a higher incidence of complications and possible low yield.
Methods
An analysis was conducted on colonoscopies performed in our center on patients 40 years of age or younger. The study population was sub-divided into 2 age groups for analysis: <30 years of age and 30–39 years of age.
Results
We recruited 453 patients for the study. Patients were 115 and 338 individuals that were <30 and 30–39 years of age, respectively. Hemorrhoids was identified as the cause of bleeding in the majority of cases. The overall incidence of polyps was 6.5%; this was significantly higher in the 30–39 age group (7.4% vs. 1.7%, p=0.026). There were two cases of advanced/malignant polyps. While the majority of the polyps were in the distal colon, 28% of the polyps in the older age group were found in the proximal colon. There was one case of colonic perforation.
Conclusions
Colonic polyps are more prevalent in patients aged 30–39. Colonoscopies should be considered for patients over the age of 30 with rectal bleeding.

Citations

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    Adhari Alzaabi, Hafsa Al Rasbi, Zayana Almaawali, Yaqeen Alyahmadi, Said A. Al-Busafi
    Medicina.2026; 62(2): 374.     CrossRef
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    Rawand Haweizy, Farman N Qader
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    Ibrahim M. Obeidat, Yousef Yahia, Prem Chandra, Amani Altaiam, Ethar Mohamed, Husam Saffo, Raya Abualsuod, Ala’a Al-deen Mousa, Duha Shalatouni, Khaled Alsa’ed, Mahmoud Y. Arabyat
    International Journal of Colorectal Disease.2024;[Epub]     CrossRef
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    Zhiang Li, Fei Yu, Chaoqian Wang, Zhang Du
    Medicine.2023; 102(37): e34941.     CrossRef
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    Tuane Colles, Patrícia K. Ziegelmann, Daniel C. Damin
    International Journal of Colorectal Disease.2023;[Epub]     CrossRef
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    Hee Chan Yang, Sang Wook Kim
    Clinical Endoscopy.2020; 53(4): 385.     CrossRef
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  • 107 Download
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Case Report
Endoscopic Ultrasound-Guided Vascular Therapy for Portoduodenal Fistula
Tanyaporn Chantarojanasiri, Apichet Sirinawasatien, Chalermrat Bunchorntavakul, Aroon Siripun, Sa-ard Treepongkaruna, Thawee Ratanachu-ek
Clin Endosc 2020;53(6):750-753.   Published online February 13, 2020
DOI: https://doi.org/10.5946/ce.2019.167
AbstractAbstract PDFPubReaderePub
Portoenteric fistula is a rare cause of massive upper gastrointestinal bleeding. Most cases can be treated with radiointervention or surgery, but portoenteric fistula is associated with a high mortality. We reported a case of intermittent massive upper gastrointestinal bleeding in a 33-year-old man with cholangiocarcinoma who underwent surgical resection followed by chemoradiation. A portoduodenal fistula due to chronic duodenal ulceration was identified. The bleeding was successfully controlled by endoscopic ultrasound-guided coil placement through the duodenal bulb using the anchoring technique. Follow-up endoscopy and computed tomography scan showed multiple coil placements between a part of the portal vein and the duodenal bulb without any evidence of portal vein thrombosis. There were no complications, and bleeding did not recur during the 8-month follow-up period.

Citations

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  • Management of Portal Vein Thrombosis and Porto-enteric Fistula Following Whipple Procedure: A Multimodal Interventional Approach
    Kausthubh Hegde, Patrick D. Sutphin, Carlos Fernandez-Del-Castillo, Alexis M. Cahalane
    Journal of Clinical Interventional Radiology ISVIR.2026;[Epub]     CrossRef
  • An unusual case of high gastrointestinal bleeding after Whipple surgery
    E Dubois, R Geelen
    Acta Gastro Enterologica Belgica.2024; 87(3): 430.     CrossRef
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    Chaoqun Han, Xin Ling, Jun Liu, Rong Lin, Zhen Ding
    Therapeutic Advances in Gastroenterology.2022;[Epub]     CrossRef
  • A Case of an Internal Pancreatic Stent Penetrating the Portal Vein after Pancreaticoduodenectomy for Ampullary Carcinoma
    Masanobu Taniguchi, Atsushi Mitsunaka, Yumi Zen, Takayuki Higashiguchi, Masaru Nagato, Yasuhisa Tango, Ichiro Nakamura, Tomoaki Nakamura, Hisanori Shiomi
    The Japanese Journal of Gastroenterological Surgery.2022; 55(2): 99.     CrossRef
  • Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography
    Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair
    Clinical Endoscopy.2022; 55(3): 458.     CrossRef
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  • 105 Download
  • 3 Web of Science
  • 5 Crossref
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Original Article
Endoscopic Management with a Novel Over-The-Scope Padlock Clip System
Mahesh Kumar Goenka, Gajanan Ashokrao Rodge, Indrajeet Kumar Tiwary
Clin Endosc 2019;52(6):574-580.   Published online November 26, 2019
DOI: https://doi.org/10.5946/ce.2019.122
AbstractAbstract PDFPubReaderePub
Background
/Aims: The Padlock clip is a recently introduced over-the-scope clip (OTSC) that requires the use of an alternate technique and has a different design from previous OTSCs. However, data regarding its clinical use are limited. The aim of this study is to present our clinical experience using this novel Padlock clip system.
Methods
Between September 2018 and June 2019, 7 consecutive patients underwent Padlock clip application at our center by an experienced endoscopist. A Padlock clip was used for achieving hemostasis in 4 patients presenting with gastrointestinal (GI) bleeding, as well as for endoscopic full-thickness resection in the remaining 3 patients.
Results
All 7 patients achieved technical as well as clinical success, with absence of complications or rebleeding, during a follow-up of a minimum of 3 weeks. All patients were hospitalized post procedure for a minimum of 48 hours, and an absence of adverse events was noted in our patient population throughout the procedure and post-procedure period. Antiplatelet therapy was reinstated shortly after the application of the Padlock clip, with no GI bleeding observed.
Conclusions
The Padlock clip is a novel OTSC, with benefits that include safe, simple, and rapid deployment. Antiplatelet therapy may be reinstated for patients, when necessary, shortly after applying the Padlock clip due to full-thickness closure of the tissue.

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Focused Review Series: Endoscopic Hemostasis: An Overview of Principles and Recent Applications
Endoscopic Hemostasis for Non-Variceal Upper Gastrointestinal Bleeding: New Frontiers
Adam Kichler, Sunguk Jang
Clin Endosc 2019;52(5):401-406.   Published online July 16, 2019
DOI: https://doi.org/10.5946/ce.2018.103
AbstractAbstract PDFPubReaderePub
Non-variceal upper gastrointestinal bleeding (NVUGIB) refers to blood loss from the gastrointestinal tract proximal to the ligament of Treitz due to lesions that are non-variceal in origin. The distinction of the bleeding source as non-variceal is important in numerous aspects, but none more so than endoscopic approaches for successful hemostasis. When a patient presents with acute overt blood loss, NVUGIB is a medical emergency, which requires immediate intervention. There have been major strides in pharmacologic and endoscopic interventions for successful induction and remission of hemostasis in the last two decades. Despite achieving tangible improvements, the burden of the disease and the consequent mortality remain high. To address endoscopic outcomes better, several new technologies have emerged and have been subsequently incorporated to the armamentarium of hemostatic tools. This study aims to provide a succinct review on novel technologies for endoscopic hemostasis.

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Case Report
Acquired Hemophilia A with Gastrointestinal Bleeding
Narae Park, Jin Seok Jang, Jae Hwang Cha
Clin Endosc 2020;53(1):90-93.   Published online July 8, 2019
DOI: https://doi.org/10.5946/ce.2019.036
AbstractAbstract PDFPubReaderePub
Peptic ulcer disease is the most common cause of acute gastrointestinal bleeding, followed by variceal bleeding, Mallory–Weiss syndrome, and malignancy. On the contrary, acquired hemophilia A is a very rare hemorrhagic disease, which usually manifests with musculocutaneous bleeding, caused by autoantibodies against coagulation factor VIII.
A 78-year-old man presented to the Emergency Department with melena. Dieulafoy’s lesions were observed on esophagogastroduodenoscopy, and endoscopic cauterization was performed. However, the patient complained of back pain and symptoms indicative of upper gastrointestinal bleeding. Abdominopelvic computed tomography was performed, and hematoma in the psoas muscle was detected. Antibodies against coagulation factor VIII were confirmed with a blood test, and the diagnosis of acquired hemophilia A was made. Here, we report a case of acquired hemophilia A presenting with upper gastrointestinal bleeding symptoms and present a brief review of literature.

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Original Article
Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding
Gonçalo Alexandrino, Tiago Dias Domingues, Rita Carvalho, Mariana Nuno Costa, Luís Carvalho Lourenço, Jorge Reis
Clin Endosc 2019;52(1):47-52.   Published online October 5, 2018
DOI: https://doi.org/10.5946/ce.2018.093
AbstractAbstract PDFPubReaderePub
Background
/Aims: The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12–24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding.
Methods
This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding.
Results
A total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome.
Conclusions
Very early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.

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  • 12,665 View
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Case Reports
Gastric Ulceration and Bleeding with Hemodynamic Instability Caused by an Intragastric Balloon for Weight Loss
Larrite Reed, Hawa Edriss, Kenneth Nugent
Clin Endosc 2018;51(6):584-586.   Published online June 1, 2018
DOI: https://doi.org/10.5946/ce.2018.038
AbstractAbstract PDFPubReaderePub
Obesity in the United States is a medical crisis with many people attempting to lose weight with caloric restriction. Some patients choose minimally invasive weight loss solutions, such as intragastric balloon systems. These balloon systems were approved by the Federal Drug Administration (FDA) in 2015–2016 and have been considered safe, with minimal side effects. We report a patient with a two-day history of melena, abdominal pain, hypotension, and syncope which developed five months after placement of an intragastric balloon. Esophagogastroduodenoscopy with balloon removal revealed a small 8-mm gastric ulcer in the incisura. This gastric ulcer probably developed secondary to mechanical compression of the stomach mucosa by the gastric balloon which contained 900 mL of saline. The FDA is now investigating five deaths since 2016 associated with these second-generation balloons. Clinicians should be aware of these complications when evaluating patients with gastrointestinal complications, such as bleeding.

Citations

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    Solomon Raj Vasudayan, Guo Hou Loo, Guhan Muthkumaran, Nik Ritza Kosai
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  • 107 Download
  • 3 Web of Science
  • 4 Crossref
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Congenital Jejunal Diverticular Bleeding in a Young Adult
Ji-Yung Lee, Jae-Young Jang, Min-Je Kim, Tae-In Lee, Jung-Wook Kim, Young-Woon Chang
Clin Endosc 2017;50(5):495-499.   Published online June 14, 2017
DOI: https://doi.org/10.5946/ce.2016.154
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Diverticular bleeding of the small bowel is rare and occurs primarily in adults aged more than 60 years. In younger adults, Meckel’s diverticulum, a true diverticulum that congenitally occurs in the distal ileum, is the most common cause of diverticular bleeding of the small bowel. Unlike Meckel’s diverticula, other kinds of small bowel diverticula are not congenital and their incidence is related to age. Furthermore, congenital true diverticular bleeding of the jejunum in adults is very rare. We report the case of a 24-year-old man with subepithelial tumor-like lesion accompanied with obscure overt gastrointestinal bleeding (OOGIB). This lesion was initially suspected to be a subepithelial tumor based on radiologic tests and capsule endoscopy. He was finally diagnosed with a congenital true diverticulum in the jejunum with the appearance of a Meckel’s diverticulum after surgical resection.

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  • Diverticular hemorrhage of terminal ileum successfully treated by ultra-selective transcatheter arterial embolization using triaxial system: a case report
    Yuki Yaginuma, Kenichi Utano, Yuka Utano, Daiki Nemoto, Masato Aizawa, Hajime Matsuida, Noriyuki Isohata, Shungo Endo, Kazutomo Togashi
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    Lidia Ciobanu, Oliviu Pascu, Marcel Tanțău
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  • 4 Web of Science
  • 3 Crossref
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Combined Endoscopic and Surgical Treatment of Severe Gastrointestinal Bleeding in a Patient with Heart Assist Device under Therapeutic Anticoagulation
Edris Wedi, Mohamed Bounnah, Riccardo Memeo, Carlo Jung
Clin Endosc 2017;50(6):598-601.   Published online June 1, 2017
DOI: https://doi.org/10.5946/ce.2017.024
AbstractAbstract PDFPubReaderePub
Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot. A combined endoscopic and surgical treatment was initiated, including gastrotomy for blood clot removal, surgical transgastric suturing, endoscopic over-the-scope clip (OTSC) placement and hemospray application. Postoperative endoscopic visualization showed effective bleeding control. The patient unfortunately died due to causes unrelated to the treatment. This case shows that a minimal invasive combination of endoscopic and surgical techniques can be an alternative treatment for severe upper GI bleeding in critically ill and anticoagulated patients.
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Original Article
Endoscopic Management of Gastrointestinal Leaks and Bleeding with the Over-the-Scope Clip: A Prospective Study
Mahesh Kumar Goenka, Vijay Kumar Rai, Usha Goenka, Indrajit Kumar Tiwary
Clin Endosc 2017;50(1):58-63.   Published online October 31, 2016
DOI: https://doi.org/10.5946/ce.2016.028
AbstractAbstract PDFPubReaderePub
Background
/Aims: The over-the-scope clip (OTSC) is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC.
Methods
Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI) leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal) and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip.
Results
All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10). Antiplatelet therapy was continued in patients with GI bleeding.
Conclusions
In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding.

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Review
Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding
Ari Garber, Sunguk Jang
Clin Endosc 2016;49(5):421-424.   Published online September 30, 2016
DOI: https://doi.org/10.5946/ce.2016.110
AbstractAbstract PDFPubReaderePub
Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical), EndoClot (EndoClot Plus Inc.), and Ankaferd Blood Stopper (Ankaferd Health Products), in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.

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Case Report
Multiple Polypoid Angiodysplasia with Obscure Overt Bleeding
Jooyoung Lee, Sung Wook Hwang, Jihye Kim, Jinwoo Kang, Gyeong Hoon Kang, Kyu Joo Park, Jong Pil Im, Joo Sung Kim
Clin Endosc 2016;49(1):91-96.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.91
AbstractAbstract PDFPubReaderePub
Angiodysplasia (AD) is increasingly being recognized as a major cause of gastrointestinal bleeding. Morphologically flat lesions are common types of AD, whereas the polypoid types are rare. We report a case of multiple polypoid AD in the small bowel causing severe anemia and requiring surgical treatment. A 60-year-old male patient visited our hospital with dyspnea and hematochezia. He had a history of myocardial infarction and was taking both aspirin and clopidogrel. Capsule endoscopy, enteroscopy, computed tomography, and angiography revealed multifocal vascular lesions with a polypoid shape in the jejunum. Surgical resection was performed because endoscopic treatment was considered impossible with the number and the location of lesions. The risk of recurrent bleeding related to the use of antiplatelet agents also contributed to the decision to perform surgery. AD was histologically diagnosed from the surgical specimen. He resumed taking both aspirin and clopidogrel after surgery. He fully recovered and has been doing well during the several months of follow-up.

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Original Articles
The AIMS65 Score Is a Useful Predictor of Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding: Urgent Endoscopy in Patients with High AIMS65 Scores
Sun Wook Park, Young Wook Song, Dae Hyun Tak, Byung Moo Ahn, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong
Clin Endosc 2015;48(6):522-527.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.522
AbstractAbstract PDFPubReaderePub
Background
/Aims: To validate the AIMS65 score for predicting mortality of patients with nonvariceal upper gastrointestinal bleeding and to evaluate the effectiveness of urgent (<8 hours) endoscopic procedures in patients with high AIMS65 scores.
Methods
This was a 5-year single-center, retrospective study. Nonvariceal, upper gastrointestinal bleeding was assessed by using the AIM65 and Rockall scores. Scores for mortality were assessed by calculating the area under the receiver-operating characteristic curve (AUROC). Patients with high AIMS65 scores (≥2) were allocated to either the urgent or non-urgent endoscopic procedure group. In-hospital mortality, success of endoscopic procedure, recurrence of bleeding, admission period, and dose of transfusion were compared between groups.
Results
A total of 634 patients were analyzed. The AIMS65 score successfully predicted mortality (AUROC=0.943; 95% confidence interval [CI], 0.876 to 0.99) and was superior to the Rockall score (AUROC=0.856; 95% CI, 0.743 to 0.969) in predicting mortality. The group with high AIMS65 score included 200 patients. The urgent endoscopic procedure group had reduced hospitalization periods (p<0.05)
Conclusions
AIMS65 score may be useful in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding. Urgent endoscopic procedures in patients with high scores may be related to reduced hospitalization periods.

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  • ASSESSMENT OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING USING AIMS65 SCORE
    Farahnaz Joukar, Raheleh Sadat Hosseini Basti, Fakhrieh Sadat Hosseini Basti, Fatemeh Mosafer, Hoorieh Sadat Hosseini Basti, Zahra Hedayatzadeh, Afshin Shafaghi
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    Heung Up Kim
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    Joon Sung Kim, Byung-Wook Kim
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Predictors of Rebleeding in Upper Gastrointestinal Dieulafoy Lesions
Sang-Hun Park, Du-Hyeon Lee, Chang-Hwan Park, Jin Jeon, Ho-Jun Lee, Sung-Uk Lim, Seon-Young Park, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew
Clin Endosc 2015;48(5):385-391.   Published online September 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.5.385
AbstractAbstract PDFPubReaderePub
Background/Aims

Dieulafoy lesions (DLs) are a rare but significant cause of upper gastrointestinal bleeding. We aimed to define the clinical significance of rebleeding and identify the predictors of rebleeding and mortality in upper gastrointestinal Dieulafoy lesions (UGIDLs).

Methods

Patients diagnosed with UGIDLs between January 2004 and June 2013 were retrospectively evaluated. Multivariate logistic regression analyses were performed to define the predictors of rebleeding and mortality in patients with UGIDLs.

Results

The study group consisted of 81 male and 36 female patients. Primary hemostasis was achieved in 115 out of 117 patients (98.3%) with various endoscopic therapies. Rebleeding occurred in 10 patients (8.5%). The mortality rate was significantly higher in patients with rebleeding than in those without rebleeding (30.0% vs. 4.7%, p=0.020). Multivariate logistic regression analysis revealed that kidney disease (p=0.006) and infection (p=0.005) were significant predictors of rebleeding in UGIDLs and that kidney disease (p=0.004) and platelet count (p=0.013) were significant predictors of mortality.

Conclusions

Rebleeding has an important prognostic significance in patients with UGIDLs. Kidney disease and infection are major predictors of rebleeding and mortality in patients with UGIDLs.

Citations

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Case Report
Eosinophilic Gastroenteritis Due to Rhus Ingestion Presenting with Gastrointestinal Hemorrhage
Wonsuk Choi, Seon-Young Park, Chan Choi, Kyuman Cho, Chang-Hwan Park, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew
Clin Endosc 2015;48(2):174-177.   Published online March 27, 2015
DOI: https://doi.org/10.5946/ce.2015.48.2.174
AbstractAbstract PDFPubReaderePub

Rhus-related illnesses in Korea are mostly caused by ingestion of parts of the Rhus tree. Contact dermatitis occurrence after ingestion of Rhus-related food is very common in Korea. However, Rhus-related gastrointestinal disease is very rare. Herein, we present a case of eosinophilic gastroenteritis caused by Rhus ingestion. A 75-year-old woman was admitted with hematemesis and hematochezia after Rhus extract ingestion. Routine laboratory tests revealed leukocytosis without eosinophilia. Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops. Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen. Her symptoms improved after avoidance of the allergen.

Citations

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    S. J. Park, J. W. Park, K. Y. Park, K. Li, S. J. Seo, B. J. Kim, K. H. Yoo
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    Valentín Gonzalez-Canalizo, Nerea Segues, Andrea Medina, Silvia Torrente, Vanessa Aguilar-Gama, Paula Ortega, Luis Bujanda
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    Valentín Gonzalez-Canalizo, Nerea Segues, Andrea Medina, Silvia Torrente, Vanessa Aguilar-Gama, Paula Ortega, Luis Bujanda
    Gastroenterología y Hepatología (English Edition).2019; 42(5): 307.     CrossRef
  • 11,102 View
  • 91 Download
  • 3 Web of Science
  • 4 Crossref
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Review
Should Capsule Endoscopy Be the First Test for Every Obscure Gastrointestinal Bleeding?
Chung Hyun Tae, Ki-Nam Shim
Clin Endosc 2014;47(5):409-414.   Published online September 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.5.409
AbstractAbstract PDFPubReaderePub

Obscure gastrointestinal bleeding (OGIB) refers to gastrointestinal (GI) bleeding of unclear origin that persists or recurs after negative findings on esophagogastroduodenoscopy and colonoscopy. OGIB accounts for approximately 5% of all types of GI bleeding. More than 80% of OGIB cases originate in the small bowel. The ability to detect OGIB in the small bowel has significantly advanced and been revolutionized since the introduction of the capsule endoscopy and double-balloon enteroscopy techniques in 2000 and 2001, respectively. With these new methods for small-bowel evaluation, new guidelines have been proposed for the diagnosis and management of OGIB. However, some issues remain unsolved. The purpose of this article is to review the various modalities used for evaluating OGIB, including capsule endoscopy and double-balloon enteroscopy, and to help guide clinicians in their decisions on which modality will be the most effective.

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Case Reports
Endoscopic Management of Rectal Dieulafoy's Lesion: A Case Series and Optimal Treatment
Jung Gil Park, Jung Chul Park, Yong Hwan Kwon, Sun Young Ahn, Seong Woo Jeon
Clin Endosc 2014;47(4):362-366.   Published online July 28, 2014
DOI: https://doi.org/10.5946/ce.2014.47.4.362
AbstractAbstract PDFSupplementary MaterialPubReaderePub

Rectal Dieulafoy's lesion (DL) is rare cause of lower gastrointestinal bleeding. Because of its rarity, there is no consensus on the optimal endoscopic hemostasis technique for rectal DL. We analyzed six patients who underwent endoscopic management for rectal DL after presenting with hematochezia at a single institute over 10 years. Of the six patients, three underwent endoscopic band ligation (EBL) and three underwent endoscopic hemoclip placement (EHP). Only one patient was treated with thermocoagulation. There were no immediate complications in any of the patients. None of the patients required a procedure or surgery for the treatment of rebleeding. Mean procedure times of EBL and EHP were 5.25 minutes and 7 minutes, respectively. Both EHP and EBL are shown to be effective in the treatment of bleeding rectal DL. We suggest that EBL may have potential as the preferred therapy owing to its superiority in technical and economic aspects, especially in elderly and high-risk patients.

Citations

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  • Massive gastrointestinal bleeding due to a Dieulafoy jejunal lesion: a case report
    Roberto José González Zambrana, Katerin Yaritza Hernández Reyes, Marion José Valladares, Cristian Geovanny Pereira Santana
    International Journal of Surgery Case Reports.2025;[Epub]     CrossRef
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    Ping Han, Demin Li, Qiaozhen Guo, Yu Lei, Jingmei Liu, Dean Tian, Wei Yan
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    Ping Han, Yu Lei, Wei Hou, Nianjun Chen, Jingmei Liu, Dean Tian, Qiaozhen Guo, Wei Yan
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    Mario Rene Pineda-De Paz, Massiel Madelin Rosario-Morel, Jose Guadalupe Lopez-Fuentes, Luis Ariel Waller-Gonzalez, Rodrigo Soto-Solis
    World Journal of Gastrointestinal Endoscopy.2019; 11(7): 438.     CrossRef
  • Georges-Paul Dieulafoy (1839–1911) de l’ulcération…
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    Omar N Nadhem, Omar A Salh, Omar H Bazzaz
    SAGE Open Medical Case Reports.2017;[Epub]     CrossRef
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Two Cases of Ileal Dieulafoy Lesion with Massive Hematochezia Treated by Single Balloon Enteroscopy
Young Chul Choi, Sang Hyun Park, Byoung Wook Bang, Kye Sook Kwon, Hyung Gil Kim, Yong Woon Shin
Clin Endosc 2012;45(4):440-443.   Published online November 30, 2012
DOI: https://doi.org/10.5946/ce.2012.45.4.440
AbstractAbstract PDFPubReaderePub

Ileal Dieulafoy lesion is an unusual vascular abnormality that can cause gastrointestinal bleeding. It can be associated with massive, life-threatening hemorrhage and requires urgent angiographic intervention or surgery. Ileal Dieulafoy lesion is hard to recognize due to inaccessibility and normal-appearing mucosa. With advances in endoscopy, aggressive diagnostic and therapeutic approaches including enteroscopy have recently been performed for small bowel bleeding. We report two cases of massive ileal Dieulafoy lesion bleeding diagnosed and treated successfully by single balloon enteroscopy with a review of the literature.

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    Lauren Wallace, Peter J Gallagher
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    Aleena Jain, Manjusha Karegar, Amita Joshi, Amey Rojekar
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    Terence C. Chua, Anthony J. Gill, Jaswinder S. Samra
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  • 46 Download
  • 5 Crossref
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Special Issue Articles of IDEN 2012
Management of Non-Variceal Upper Gastrointestinal Bleeding
Seung Young Kim, Jong Jin Hyun, Sung Woo Jung, Sang Woo Lee
Clin Endosc 2012;45(3):220-223.   Published online August 22, 2012
DOI: https://doi.org/10.5946/ce.2012.45.3.220
AbstractAbstract PDFPubReaderePub

Upper gastrointestinal bleeding (UGIB) is a critical condition that demands a quick and effective medical management. Non-variceal UGIB, especially peptic ulcer bleeding is the most significant cause. Appropriate assessment and treatment have a major influence on the prognosis of patients with UGIB. Initial fluids resuscitation and/or transfusion of red blood cells are necessary in patients with clinical evidence of intravascular volume depletion. Endoscopy is essential for diagnosis and treatment of UGIB, and should be provided within 24 hours after presentation of UGIB. Pre-endoscopic use of intravenous proton pump inhibitor (PPI) can downstage endoscopic signs of hemorrhage. Post-endoscopic use of high-dose intravenous PPI can reduce the risk of rebleeding and further interventions such as repeated endoscopy and surgery. Eradication of Helicobacter pylori and withdrawal of non-steroidal anti-inflammatory drugs are recommended to prevent recurrent bleeding.

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    Abed H AlLehibi, Faisal F Alsubaie, Rayan H Alzahrani, Hussain A Ekhuraidah, Mohammed A Koshan, Nasser F Alotaibi, Fahad M Alotaibi, Hamdan S Alghamdi, Abdulrahman A Aljumah
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    Sreeja Ankireddypalli
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  • Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate
    Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Mario Martinotti, Gabriele Rozzi, Federico Buffoli
    World Journal of Gastroenterology.2016; 22(48): 10609.     CrossRef
  • Low hemoglobin levels are associated with upper gastrointestinal bleeding
    Minoru Tomizawa, Fuminobu Shinozaki, Rumiko Hasegawa, Yoshinori Shirai, Yasufumi Motoyoshi, Takao Sugiyama, Shigenori Yamamoto, Naoki Ishige
    Biomedical Reports.2016; 5(3): 349.     CrossRef
  • Change ratio of hemoglobin has predictive value for upper gastrointestinal bleeding
    Minoru Tomizawa, Fuminobu Shinozaki, Rumiko Hasegawa, Yoshinori Shirai, Yasufumi Motoyoshi, Takao Sugiyama, Shigenori Yamamoto, Naoki Ishige
    Biomedical Reports.2016; 5(4): 479.     CrossRef
  • Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding
    Minoru Tomizawa
    World Journal of Gastroenterology.2015; 21(20): 6246.     CrossRef
  • Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding
    Minoru Tomizawa
    World Journal of Gastroenterology.2015; 21(24): 7500.     CrossRef
  • Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding
    Ki Bae Kim, Soon Man Yoon, Sei Jin Youn
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  • Upper Endoscopy in International Digestive Endoscopy Network 2012: Towards Upper End of Quality
    Il Ju Choi
    Clinical Endoscopy.2012; 45(3): 217.     CrossRef
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Case Report
Ectopic Pancreas Bleeding in the Jejunum Revealed by Capsule Endoscopy
Mi-Jeong Lee, Jae Hyuck Chang, Il Ho Maeng, Jin Young Park, Yun Sun Im, Tae Ho Kim, Sok-Won Han, Do Sang Lee
Clin Endosc 2012;45(3):194-197.   Published online August 22, 2012
DOI: https://doi.org/10.5946/ce.2012.45.3.194
AbstractAbstract PDFPubReaderePub

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.

Citations

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  • Various Phenotypes of Ectopic Pancreatic Tissue in Children: Case Series and Literature Review
    Elena Roxana Matran, Andra-Mihaela Diaconu, Oana Neagu, Alexandru-Ioan Ulmeanu
    Diagnostics.2025; 15(10): 1193.     CrossRef
  • Heterotopic Pancreas in the Gallbladder: An Incidental Finding Following Laparoscopic Cholecystectomy in a Patient With Cholelithiasis
    Aram Farhoudian, Sepideh Hadimaleki, Bahareh Mehramouz, Amirreza Khalaji
    Clinical Case Reports.2025;[Epub]     CrossRef
  • Obscure gastrointestinal bleeding: case report of ectopic pancreas associated with small bowel angiodysplasia
    Fernando Girardi da Silva, Claudio Lucas Silva Cunha, Marina Capovilla Venturini Souza, Ana Luísa Costa Bezerra, Alexandre Foratto, Cesar Vanderlei Carmona, Talita Sansoni, Vânia Graner Silva Pinto, Thiago R A Calderan, Vitor Favali Kruger, Simone Reges P
    Journal of Surgical Case Reports.2025;[Epub]     CrossRef
  • Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study
    Xiaofeng Yang, Chen Liu, Shuai Sun, Chao Dong, Shanshan Zhao, Zaitun M. Bokhary, Na Liu, Jinghua Wu, Guojian Ding, Shisong Zhang, Lei Geng, Hongzhen Liu, Tingliang Fu, Xiangqian Gao, Qiong Niu
    Pediatric Surgery International.2024;[Epub]     CrossRef
  • Gastric Ectopic Pancreas With Pseudocyst Formation Causing Gastric Outlet Obstruction
    Austin Dickerson, Aran Farrell, Abida Bushra, Scott Celinski, Vani J.A. Konda, Hemangi Kale, Anh D. Nguyen
    ACG Case Reports Journal.2023; 10(2): e00988.     CrossRef
  • The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy
    Masanari Sekine, Takeharu Asano, Hirosato Mashima
    Diagnostics.2022; 12(4): 810.     CrossRef
  • A modern view at the treatment of ectopic pancreas in the gastro-duodenal zone in children (a literature review)
    G. N. Rumyantseva, E. I. Kazakova, Yu. F. Brevdo, A. N. Kazakov
    Russian Journal of Pediatric Surgery.2022; 26(1): 18.     CrossRef
  • Unusual Cause of GI Bleed—Ectopic Pancreas
    Sivarahini Ganesan, Kannan Devy Gounder, Anbalagan Pichaimuthu
    Indian Journal of Surgery.2021; 83(6): 1584.     CrossRef
  • Role of Video Capsule in Small Bowel Bleeding
    Richard M. Wu, Laurel R. Fisher
    Gastrointestinal Endoscopy Clinics of North America.2021; 31(2): 277.     CrossRef
  • Heterotopic pancreas adenocarcinoma in the stomach: A case report and literature review
    Yao Xiong, Yue Xie, Dan-Dan Jin, Xin-Ying Wang
    World Journal of Clinical Cases.2020; 8(10): 1979.     CrossRef
  • A case of ectopic pancreas in the ileum presenting as obscure gastrointestinal bleeding and abdominal pain
    Rugile Mickuniene, Ieva Stundiene, Tomas Jucaitis, Dileta Valanciene, Jonas Valantinas
    BMC Gastroenterology.2019;[Epub]     CrossRef
  • Endoscopic ultrasonography diagnosis of subepithelial lesions
    Mitsuhiro Kida, Yusuke Kawaguchi, Eiji Miyata, Rikiya Hasegawa, Toru Kaneko, Hiroshi Yamauchi, Shuko Koizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Hidehiko Kikuchi, Maya Watanabe, Hiroshi Imaizumi, Wasaburo Koizumi
    Digestive Endoscopy.2017; 29(4): 431.     CrossRef
  • The Role of Laparoscopy in the Management of a Diagnostic Dilemma: Jejunal Ectopic Pancreas Developing into Jejunojejunal Intussusception
    Alessio Giordano, Giovanni Alemanno, Carlo Bergamini, Paolo Prosperi, Alessandro Bruscino, Andrea Valeri
    Case Reports in Surgery.2017; 2017: 1.     CrossRef
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    Ling Tong, Huaxiong Pan, Jun He, Mixia Weng, Liduan Zheng
    Medicine.2016; 95(33): e4067.     CrossRef
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    Alfredas Kilius, Narimantas Evaldas Samalavicius, Donatas Danys, Gytis Zaldokas, Dmitrij Seinin
    Journal of Medical Case Reports.2015;[Epub]     CrossRef
  • Endosonographic Features of Histologically Proven Gastric Ectopic Pancreas
    Jen-Wei Chou, Ken-Sheng Cheng, Chun-Fu Ting, Chun-Lung Feng, Yu-Ta Lin, Wen-Hsin Huang
    Gastroenterology Research and Practice.2014; 2014: 1.     CrossRef
  • Endoscopic ultrasonography appearance of pancreatic rest
    Hideki Kumagai, Koji Yokoyama, Wakamichi Shimamura, Yoshimasa Miura, Takanori Yamagata
    Pediatrics International.2014; 56(4): 654.     CrossRef
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Original Article
Clinical Outcomes and Risk Factors of Rebleeding Following Endoscopic Therapy for Nonvariceal Upper Gastrointestinal Hemorrhage
Ki Tae Suk, Hyun-Soo Kim, Chang Seob Lee, Il Young Lee, Moon Young Kim, Jae Woo Kim, Soon Koo Baik, Sang Ok Kwon, Dong Ki Lee, Young Lim Ham
Clin Endosc 2011;44(2):93-100.   Published online December 31, 2011
DOI: https://doi.org/10.5946/ce.2011.44.2.93
AbstractAbstract PDFPubReaderePub
Background/Aims

Rebleeding after endoscopic therapy for non-variceal upper gastrointestinal hemorrhage (NGIH) is the most important predictive factor of mortality. We evaluated the risk factors of rebleeding in patients undergoing endoscopic therapy for the NGIH.

Methods

Between January 2003 and January 2007, 554 bleeding events in 487 patients who underwent endoscopic therapy for NGIH were retrospectively enrolled. We reviewed the clinicoendoscopical characteristics of patients with rebleeding and compared them with those of patients without rebleeding.

Results

The incidence of rebleeding was 21.7% (n=120). In the multivariate analysis, initial hemoglobin level ≤9 g/dL (p=0.002; odds ratio [OR], 2.433), inexperienced endoscopist with less than 2 years of experience in therapeutic endoscopy (p=0.001; OR, 2.418), the need for more 15 cc of epinephrine (p=0.001; OR, 2.570), injection therapy compared to thermal and injection therapy (p=0.001; OR, 2.840), and comorbidity with chronic renal disease (p=0.004; OR, 2.908) or liver cirrhosis (p=0.010; OR, 2.870) were risk factors for rebleeding following endoscopic therapy.

Conclusions

Together with patients with low hemoglobin level at presentation, chronic renal disease, liver cirrhosis, the need for more 15 cc of epinephrine, or therapy done by inexperienced endoscopist were risk factors for the development of rebleeding.

Citations

Citations to this article as recorded by  
  • Experience of the endoscopist mediates the association between weekend effect with rebleeding after endoscopic treatment for Dieulafoy’s lesion
    Jiayu Qiu, Yanhong Xia, Ruiying Ding, Qingping Ouyang, Liping Wang, Yang Huang, Sihai Chen, Zhenzhen Yang, Xu Shu, Xiaolin Pan, Yanxia Zhang
    Surgical Endoscopy.2026; 40(2): 1401.     CrossRef
  • Dieulafoy’s lesion of the upper GI tract: a comprehensive nationwide database analysis
    Yichen Wang, Pardeep Bansal, Si Li, Zaid Iqbal, Mahesh Cheryala, Marwan S. Abougergi
    Gastrointestinal Endoscopy.2021; 94(1): 24.     CrossRef
  • Analysis of rebleeding in cases of an upper gastrointestinal bleed in a single center series
    Rita Jiménez Rosales, Juan Gabriel Martínez-Cara, Francisco Vadillo-Calles, Eva Julissa Ortega-Suazo, Patricia Abellán-Alfocea, Eduardo Redondo-Cerezo
    Revista Española de Enfermedades Digestivas.2018;[Epub]     CrossRef
  • Continuing use of antithrombotic medications for patients with bleeding gastroduodenal ulcer requiring endoscopic hemostasis: a case–control study
    Keisuke Kawasaki, Shotaro Nakamura, Koichi Kurahara, Tomohiro Nagasue, Shunichi Yanai, Akira Harada, Hiroki Yaita, Tadahiko Fuchigami, Takayuki Matsumoto
    Scandinavian Journal of Gastroenterology.2017; : 1.     CrossRef
  • Multidisciplinary Approach to Refractory Upper Gastrointestinal Bleeding: Case Series of Angiographic Embolization
    Ko Eun Lee, Ki-Nam Shim, Chung Hyun Tae, Min Sun Ryu, Sun Young Choi, Chang Mo Moon, Seong-Eun Kim, Hey-Kyung Jung, Sung-Ae Jung
    Journal of Korean Medical Science.2017; 32(9): 1552.     CrossRef
  • Successful Endoscopic Hemostasis Is a Protective Factor for Rebleeding and Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding
    Yong Jae Han, Jae Myung Cha, Jae Hyun Park, Jung Won Jeon, Hyun Phil Shin, Kwang Ro Joo, Joung Il Lee
    Digestive Diseases and Sciences.2016; 61(7): 2011.     CrossRef
  • Rebleeding after Initial Endoscopic Hemostasis in Peptic Ulcer Disease
    Mi Jin Hong, Sun-Young Lee, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park, Chan Sup Shim, Choon Jo Jin
    Journal of Korean Medical Science.2014; 29(10): 1411.     CrossRef
  • Chronic Kidney Disease, Hemodynamic Instability, and Endoscopic High-Risk Appearance Are Associated with 30-Day Rebleeding in Patients with Non-Variceal Upper Gastrointestinal Bleeding
    Yoo Jin Lee, Eun Soo Kim, Yu Jin Hah, Kyung Sik Park, Kwang Bum Cho, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang
    Journal of Korean Medical Science.2013; 28(10): 1500.     CrossRef
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A Case of Ischemic Colitis Results from the Bleeding on Gastric Dieulafoy Lesions
Jun Seok Park, M.D., Jin Oh Kim, M.D., Hyun Gun Kim, M.D., Tae Hee Lee, M.D., Sung Wook Hong, M.D., Sung Gon Jun, M.D., Seong Ran Jeon, M.D. and Wan Jung Kim, M.D.
Korean J Gastrointest Endosc 2011;42(4):255-258.   Published online April 28, 2011
AbstractAbstract PDF
Ischemic colitis is the most common ischemic injury of the gastrointestinal tract. It can result from ischemia caused by compromised blood flow to the mesenteric arteries. Colonic ischemia may be precipitated by several conditions, although a cause is not clearly identified in most cases. A 63-year-old man was admitted because of loss of consciousness with melena. After endoscopic bleeding control of Dieulafoy lesions of the stomach, hematochezia occurred during the in-hospital care period. A sigmoidoscopy and computed tomography scan were conducted to evaluate the hematochezia, and ischemic colitis was diagnosed. Here, we report a case of ischemic colitis associated with massive upper gastrointestinal bleeding. (Korean J Gastrointest Endosc 2011;42:255-258)
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Gastric Mucosal Hemorrhage in a Patient with Idiopathic Thrombocytopenic Purpura
Do Hyung Kim, M.D., Chang-Il Kwon, M.D., Jun Gu Chung, M.D., Woong Park, M.D., Yong Hun Kim, M.D., Haeyoon Kang, M.D.*, Kwang Hyun Ko, M.D. and Doyeun Oh, M.D.
Korean J Gastrointest Endosc 2011;42(4):241-244.   Published online April 28, 2011
AbstractAbstract PDF
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune condition in which antibodies react against platelets and cause platelet destruction and bleeding that rarely results in gastrointestinal bleeding. Even though it is still controversial, a recent study suggested that Helicobacter pylori is one of the causes of ITP, and that eradication of H. pylori may be helpful for improving platelet count. We report a case of isolated gastric mucosal hemorrhage not related to H. pylori infection in a patient with ITP. A gastric mucosal biopsy revealed mild lamina proprial edema and extravasated red blood cells but no evidence of vasculitis or inflammatory cell infiltration. Thrombocytopenia can lead to a gastric mucosal hemorrhage not related to an H. pylori infection when treating patients with ITP. (Korean J Gastrointest Endosc 2011;42:241-244)
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A Case of Esophageal Pyogenic Granuloma
Hyun Sun Cho, M.D., Eun Sun Jung, M.D.*, Yune Jung Lee, M.D., Chul Hyun Lim, M.D., Woong-Ryong Jung, M.D., Hye Young Sung, M.D., Jae Myung Park, M.D. and Myung-Gyu Choi, M.D.
Korean J Gastrointest Endosc 2009;38(4):210-213.   Published online April 30, 2009
AbstractAbstract PDF
Pyogenic granulomas (PGs) are rare benign lobular capillary hemangiomas that occur on the skin or mucosa. The most common sites of PG occurrence are the skin, lip, face and finger. This entity is extremely rare in the alimentary tract, with the exception of the oral cavity. We describe here a 72-year-old man who presented with dysphagia due to the presence of a pyogenic granuloma. The tumor was located in the mid-esophagus and it was treated with endoscopic submucosal dissection. PG is considered a lesion of reactive origin that may develop in response to trauma, infection, pregnancy, angiogenic factors or hormones. Gastrointestinal PG need to be treated because it is a rare cause of gastrointestinal hemorrhage, and it is hard to differentiate from tumorous conditions such as Kaposi's sarcoma. (Korean J Gastrointest Endosc 2009;38:210-213)
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Retrieval of a Retained Capsule due to Isolated Crohn's Enteritis by Means of Double Balloon Enteroscopy
Kon-Ho Shim, M.D., Soo-Yeon Jung, M.D., Jun-Ho Song, M.D., Hyeug Lee, M.D., Eui-Hyung Kim, M.D., Eun-Jung Jeon, M.D., Jung-Hwan Oh, M.D., Jeong-Jo Jeong, M.D., Hwang Choi, M.D. and Sang-Wook Choi, M.D.
Korean J Gastrointest Endosc 2007;35(6):399-403.   Published online December 30, 2007
AbstractAbstract PDF
Capsule endoscopy is being increasingly used for investigating GI bleeding of an obscure origin and also the bleeding that's due to Crohn's disease. Capsule endoscopy is a safe procedure with few complications. Complications of capsule endoscopy are capsule retention, incomplete small bowel examination, swallowing disorders and technical complications. However, capsule retention still remains a major concern. Crohn's disease may rarely show its first manifestation as GI bleeding. We present here a case of obscure GI bleeding in which the diagnosis of isolated Crohn's enteritis was made by using wireless CE. The retained capsule at the jejunal stricture of Crohn's disease was successfully retrieved by performing double balloon enteroscopy. (Korean J Gastrointest Endosc 2007;35:399-403)
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A Case of Gastrointestinal Stromal Tumor of the Jejunum with Obscure Gastrointestinal Hemorrhage Diagnosed by Exploratory Laparotomy
Hae Bin Jung, M.D., Sun Young Kim, M.D., Shin Ae Park, M.D., Sang Mi Park, M.D., Kon Ho Shim, M.D., Eui Hyung Kim, M.D., Eun Jung Jeon, M.D., Jung Hwan Oh, M.D., Jeong Jo Jeong, M.D. and Sang Wook Choi, M.D.
Korean J Gastrointest Endosc 2007;34(6):334-338.   Published online June 30, 2007
AbstractAbstract PDF
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract, and they represent about 2% of all neoplasms of the gastrointestinal tract. GISTs primarily affect the stomach (50∼60%), but they can also affect the small intestine (20∼30%), large intestine (7%) and esophagus (1%). The clinical manifestations of GISTs vary according to the location and size of the mass. GISTs are generally KIT (CD117)-positive and are diagnosed by immunohistochemistry. Tumor size and mitotic activity are the best predictive prognostic features. The treatment of choice for primary GIST is complete surgical resection with a negative margin. A 78-year-old man who presented with melena and diffuse abdominal pain was admitted to our hospital. Esophagogastroduodenoscopy, colonoscopy, angiography and an RBC scan were performed but we were unable to locate the focus of the hemorrhage. A gastrointestinal stromal tumor (GIST) of the jejunum was diagnosed after laparotomy.
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A Case of Giant Brunner's Gland Hamartoma Presenting as Gastrointestinal Hemorrhage
Sang Yong Lee, M.D., Jung Hyun Lee, M.D., Hyo Jin Jung, M.D., Joo Ho Lee, M.D., Tae Oh Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.
Korean J Gastrointest Endosc 2007;34(1):47-50.   Published online January 30, 2007
AbstractAbstract PDF
Brunner's gland hamartoma is also called Brunner's gland adenoma and Brunner's gland hyperplasia of Brunneroma, and it is a rare tumor of the duodenum. This tumor is caused by a benign proliferation of Brunner's glands, and the disease is normally present on the duodenum. These tumors arise mainly in the duodenal bulb and only rarely in the jejunum and proximal ileum. The clinical manifestations are nonspecific gastrointestinal complaints such as bloating or epigastric pain, and the tumor often gives rise to melena or obstruction. We report here on a case of a giant Brunner's gland hamartoma in a 48 year-old woman, and it was treated by endoscopic polypectomy. We also include a review of the related literatures.
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A Case of Endoscopically Treated Jejunal Bleeding from Polyarteritis Nodosa
Hyeok Choon Kwon, M.D., Jeong Woo Choi, M.D., Seung Jun Choi, M.D., Seung Il Woo, M.D., Joo Sung Sun, M.D.*, Je Hwan Won, M.D.*, Chang Hee Suh, M.D.†, Kee Myung Lee, M.D., Ki Baik Hahm, M.D. and Jin Hong Kim, M.D.
Korean J Gastrointest Endosc 2006;32(1):48-52.   Published online January 30, 2006
AbstractAbstract PDF
Polyarteritis nodosa is a necrotizing vasculitis of the small and medium-sized arteries of multiple organ systems. The common symptoms of gastrointestinal involvement are abdominal pain, nausea, and vomiting. However, the symptoms at presentation are sometimes non-specific and vague. The well-known complications of gastrointestinal involvement are mucosal ulceration, bowel infarction, perforation, cholecystitis and hepatitis. We describe a case of a 6-year-old male with jejunal bleeding who was diagnosed with polyarteritis nodosa by angiography. After controlling the systemic symptoms with immunosuppressants and steroids, jejunal bleeding occurred. The jejunal bleeding was treated endoscopically with a hemoclip and increasing the immunosuppressant dose. Generally, massive gastrointestinal bleeding in a patient with polyarteritis nodosa is treated surgically. In this case, the jejunal bleeding was controlled with an endoscope because the bleeding site was located within reach of the endoscope, and systemic symptoms subsided with medication. There is no report of gastrointestinal bleeding from the polyarteritis nodosa in a child in Korea. Therefore, we report this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2006;32:48⁣52)
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A Case of Cholelithiasis with Massive Lower Gastrointestinal Bleeding
Dong Won Ahn, M.D., Sun Jung Myung, M.D., Cheol Min Shin, M.D., Su Jong Yu, M.D., Ji Won Yoo, M.D., Soo Jeong Cho, M.D., Jae Hyun Cho, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D., Yong Bum Yoon, M.D. and Jin Young Jang, M.D.*
Korean J Gastrointest Endosc 2005;31(6):432-436.   Published online December 30, 2005
AbstractAbstract PDF
Cholelithiasis is a relatively common disease and can present with various clinical manifestations and complications such as no symptoms, biliary pain, acute cholecystitis, biliary pancreatitis, acute cholangitis, gallstone ileus and biliary enteric fistula. However, cholelithiasis presenting with intra-gallbladder bleeding and massive gastrointestinal bleeding are relatively rare in the worldwide literature and there have been only a few reported case studies. We present here an interesting case of a 63 year-old women with gallstone, active intra-gallbladder bleeding and massive hematochezia who underwent open cholecystectomy, resection and anastomosis of the transverse colon. This patient's pathologic evaluation revealed a finding of acute and chronic cholecystitis with marked hemorrhage and transmural fibrinoid necrosis in the transverse colon. (Korean J Gastrointest Endosc 2005;31:432⁣436)
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Upper Gastrointestinal Hemorrhage from Pancreatic Pseudocyst Involving the Duodenum: A Case Report
Chan Ran You, M.D., Seung Whan Shin, M.D., Bo In Lee, M.D., Jeong Seon Ji, M.D., Byung Wook Kim, M.D., Hwang Choi, M.D., Se Hyun Cho, M.D., Hiun Suk Chae, M.D., Kyu Yong Choi, M.D. and In Sik Chung, M.D.
Korean J Gastrointest Endosc 2004;29(4):217-221.   Published online October 30, 2004
AbstractAbstract PDF
Most pancreatic pseudocysts are located in or around the pancreas, but they can be found in all the potential spaces around viscera in and outside of the abdominal cavity. The complications of pancreatic pseudocysts are infection, rupture, fistula, obstruction and hemorrhage. However, an upper gastrointestinal bleeding caused by pancreatic pseudocyst is rare. Pseudocysts with complication like hemorrhage require percutaneous, endoscopic or surgical treatment. We report a case of the pancreatic pseudocyst involving duodenal wall with upper gastrointestinal hemorrhage, which was improved by conservative treatment. (Korean J Gastrointest Endosc 2004;29: 217⁣221)
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비정맥류 , 비궤양성 장관 내 출혈 및 용종 제거술 후 내시경적 밴드 결찰술 ( Endoscopic Band Ligation for Non - variceal , Non - ulcer Gastrointestinal Hemorrhage and Post - polypectomy Hemorrhage )
Korean J Gastrointest Endosc 2001;23(2):76-81.   Published online November 30, 2000
AbstractAbstract PDF
Background
/Aims: There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. The purpose of this study is to define the effectiveness of endoscopic band ligation for non-variceal, non-ulcer gas- trointestinal hemorrhage and post-polypectomy hemorrhage. Methods: Twenty eight patients were treated by band ligation between July 1996 and October 2000. The lesions treated were; Dieulafoy’s lesion in 13, Mallory-Weiss tear in 7, angiodysplasia in 1, post-polypectomy bleeding in 4, post-endoscopic mucosal resection bleeding in 2, post- endoscopic biopsy bleeding in I. Results: Endoscopic band ligation was successful in 25 of 28 cases. Additional sclerotherapy was necessary in two cases of Dieulafoy’s lesion. The remaining case was early band detachment. Conclusions: Endoscopic band ligation is effective for non-variceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive. (Korean J Gastrointest Endosc 2001;23:76-81)
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Case Report
Combined Endoscopic and Surgical Treatment of Severe Gastrointestinal Bleeding in a Patient with Heart Assist Device under Therapeutic Anticoagulation
Published online November 30, 1999  
AbstractAbstract
Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot. A combined endoscopic and surgical treatment was initiated, including gastrotomy for blood clot removal, surgical transgastric suturing, endoscopic over-the-scope clip (OTSC) placement and hemospray application. Postoperative endoscopic visualization showed effective bleeding control. The patient unfortunately died due to causes unrelated to the treatment. This case shows that a minimal invasive combination of endoscopic and surgical techniques can be an alternative treatment for severe upper GI bleeding in critically ill and anticoagulated patients.
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내시경적 결찰요법으로 치유한 위 혈관이형성증 1 예 ( Endoscopic Ligation Therapy for Gastric Angiodysplasia )
Korean J Gastrointest Endosc 1999;19(3):425-429.   Published online November 30, 1998
AbstractAbstract PDF
Gastric angiodysplasia may be responsible for up to 2% to 6% of upper gastrointestinal bleeding. Moreover, gastric angiodysplasia may be particularly difficult to treat and is usually associated with a high rebleeding rate. Bleeding due to gastric angiodypsplasia is usually treated by various endoscopic approaches, including argon and Nd：YAG laser photocoagulation, monopolar or biopolar electrocoagulation, heater probe, or injection. Associated complications of these methods, however, such as perforation, acute bleeding during the procedure, or delayed massive hemorrhage have been reported. Recently a few reports have been suggested that endoscopic ligation therapy is a safe, effective treatment for gastric angiodysplasia. A 70-year-old man, who had undergone subtotal gastrectomy for perforation of a duodenal ulcer for 20 years, was admitted due to melena and dizziness persisting for 1 week. A gastroscopy revealed a single angiodysplasia with active bleeding just above the anastomotic site of the remnant stomach. Endoscopic ligation therapy was performed successfully and the bleeding stopped immediately after endoscopic ligation. Since then, no recurrence of bleeding has been reported to date. (Korean J Gastrointest Endosc 19: 425∼429, 1999)
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증례 : 식도 위장관 ; 내시경적 경화요법에 의한 십이지장 정맥류출혈의 치유 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Successful Endoscopic Injection Sclerotherapy of a Bleeding Duodenal Varix )
Korean J Gastrointest Endosc 1998;18(2):249-255.   Published online November 30, 1997
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Bleeding frorn the duodenal varix is an unusual event. Upper gastrointestinal endoscopy is the diagnostic procedure of choice in diagnosing duodenal varices. If performed during active bleeding, it can differentiate between esophageal and duodenal varices as the source, which has important therapeutic implications. A thorough examination of the duodenum for varices is important in an upper gastrointestinal hemorrhage. Treatment modalites for bleeding duodenal varices are sclerotherapy, varix suture ligation, portocaval shunt, and duodenal resection. Although endoscopic sclerotherapy has lirnited success in controlling active duodenal varix as initial treatment, endoscopic injection sclerotherapy is a useful first-line therapeutic measure in the treatment of bleeding duodenal varices. In this study we present a case of a ruptured duodenal varix, which was defected by an endoscopy, in a 61-year-old male. An endoscopic examination showed small and nonbleeding esophageal varices and a prominant ulcerated varix was identified in the 2nd portion of the duodenum. Endoscopic sclerotherapy was performed by injecting ethanolamine oleate into the varix. Our report demonstrate that endoscopic sclerotherapy can be efficient even in the presence of acute bleeding and that it can provide a definitive method of curing of a bleeding duodenal varix. (Korean J Gastrointest Endosc 18: 249-253, 1998)
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증례 : 식도 위장관 ; 내시경적 결찰요법으로 치유한 Dieulafoy 궤양 2예 ( Case Reports : Esophagus , Stomach & Intestine ; 2 Cases of Endoscopic Ligation Therapy of a Dieulafoy Ulcer )
Korean J Gastrointest Endosc 1998;18(2):225-229.   Published online November 30, 1997
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A dieulafoy ulcer is rarely recognized but is not an uncommon cause of massive, recurrent and frequently fatal gastrointestinal bleeding resulting from the erosion of an unusually large submucosal artery. Although the lesion has been predominantly found in the proximal stomach, it has also been detected throughout the gastrointestinal tract. Diagnosis can be made by observation of protruding and eroded arteries with pulsatile bleeding, or through detection of an adherent thrombus using an endoscopy. In the past, surgical intervention was believed to be the best treatment, but currently, therapeutic endoscopy is more favored, due to its recent success in achieving permanent hemostasis. We experienced 2 cases of Dieulafoy's ulcer of the stomach. Endoscopic ligations using an O ring were performed successfully. (Korean J Gastrointest Endosc 18: 225-229, 1998)
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증례 : 식도 위장관 ; 심한 상부 위장관 출혈을 유발한 십이지장 정맥류 3예 ( Case Reports : Esophagus , Stomach & Intestine ; Duodenal Varices Causing Massive Upper Gastrointestinal Hemorrhage )
Korean J Gastrointest Endosc 1996;16(3):493-503.   Published online November 30, 1995
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The bleeding duodenal varices are a rare complication in patients with portal hypertension, but present a difficult diagnostic problem. If there is no bleeding esophageal, gastric fundal varices or ulcer in a patient with upper gastrointestinal bleeding and portal hypertension, the possibility of bleeding duodenal varices should be kept in mind. Thorough endoscopic examination of the entire duodenal mucosa is essential to document bleeding from duodenal varices. As an initial treatment, endoscopic sclerotherapy has had limited success in controlling active duodenal variceal bleeding. However, rebleeding rate is high, surgical treatment including shunt operation may be required for permanent control of bleeding and portal decompression. We report three cases of duodenal varices causing massive hemorrhage. All the patients had portal hypertension caused by liver cirrhosis of various etiologies and had varices in their esophagus. The second portion of the duodenum was the site of duodenal varices in all cases. The management was tailored to the condition of each patient, but only one patient among three survived. (Korean J Gastrointest Endosc 16: 493~501, l996)
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증례 : 내시경적 결찰요법에 의한 Dieulafoy 궤양의 치료 ( Case Reports : Endoscopic Ligation Therapy of Dieulafoy Ulcer )
Korean J Gastrointest Endosc 1995;15(2):247-252.   Published online November 30, 1994
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Dieulafoy ulcer is an unusual cause of massive, recurrent and frequently fatal gastrointestinal hemorrhage that results from erosion of abnormally large submucosal artery. Although the lesion has been found throughout the gastrointestinal tract, it most commonly occurs in the proximal stomach. Diagnosis depends on the observation of protruding and eroded artery with pulsatile bleeding or adherent thrombus by endoscopy. Even during active bleeding, the endoseopic examination can be negative if intraluminal blood or clots obscure the source of bleeding. If the bleeding has stopped, the small mucosal lesion can be easily overlooked. Unlike peptic ulceration, there is no excavation of the mucosa. A 76-year-old man presented with massive hematemesis and melena. The patient had no previous history of peptic ulcer disease. He did not drink alcohol and use aspirin or NSAIDs. Physical examination revealed a pale, severely diaphoretic male with hypotension and melenic stools. He was found to have hemoglobin 4.0 g/dL and hematocrit 12.7%. We performed emergency endoscopy which showed a pulsatile and bleeding exposed artery without evidence of surrounding ulcerative lesion on the posterior wall of upper body of stomach. Endoscopic ligation using O ring of Stiegman-Goff endoscopic ligator kit was done successfully and the bleeding stopped immediately after ligation. Ten days after treatment, endoscopy showed artificial ulcerative lesion on previous ligated site and no evidence of bleeding. Another endoscopy four days later revealed healing ulcerative lesion. After improvement, the patient was discharged and rebleeding has not occurred to date.
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증례 : 담도 췌장 ; 상부위장관 출혈로 나타난 출혈성 췌장가성낭종 ( Case Reports : Biliary Tract & Pancreas ; Pancreatic Pseudocyst Causing Gastrointestinal Hemorrhage ( Hemosuccus pancreaticus ) )
Korean J Gastrointest Endosc 1995;15(4):803-809.   Published online November 30, 1994
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Hemorrhage into a pancreatic pseudocyst is a rare, but increasingly recognized as a cause of massive gastrointestial bleeding. Bleeding pseudocysts may rupture into the stomach, duodenum, common bile duct, and splenic vein, or can be decompressed via the duct of Wirsung. Also it will result in upper gastrointestinal bleeding. This represents a life-threatening and frequently unrecognized complication of pancreatic disease. Proper diagnostic workup and prompt surgical management afford the patient the best chance for survival . We report a patient with pseudocyst bleeding into the gastrointestinal tract via the duct of Wirsung and discuss the current diagnostic and therapeutic approach. (Kor J Gastrointest Endosc 15: 803-807, 1995)
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증례 : 식도 위장관 ; 내시경적 용종절제술로 치유한 십이지장의 Brunner's Gland 선종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Brunner's Gland Adenoma Treated by Endoscopic Polypectomy )
Korean J Gastrointest Endosc 1995;15(4):747-753.   Published online November 30, 1994
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The Brunner's gland adenoma is characterized by a nodular proliferation of histologically normal Brunner's gland, accompanied by ducts and scattered stromal elements. First descrived by Salvioli in 1876, the tumor is relatively rare, with 119 cases reported by 1977, The most common benign tumor of the small bowel is the adenoma, 25% of which occur in the duodenum. They make up 30% to 50% of all hyperplastic polyps of the duodenum. Most frequently these tumors are discovered in patients in the fourth to sixed decades of life, though the age in reported caes ranges from l 1 days to 80 years. The benign tumors of the duodenum 30% to 50% contain elements of Brunner's gland and 10.6% of them are adenomas of Brunner's gland. We report a case of Brunner's gland adenoma treated by endoscopic polypectomy in 63 year-old woman, and reviewed the literatues of adenoma of the Brunne'r gland. (Kor J Gastrointest Endosc 15: 747-751, 1995)
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