RESUMEN
We propose this variant of the clip technique as a method that assist traction during endoscopic submucosal dissection (ESD): traction on the mucosa plane using an hemoclip carrying a surgical silk and three rubber bands, before the incision, to allow easier access to the submucosa space. We propose this variant with the intention of facilitating access to ESD quickly and safely for beginners.
Asunto(s)
Resección Endoscópica de la Mucosa , Humanos , Resección Endoscópica de la Mucosa/métodos , Resultado del Tratamiento , Disección/métodos , Membrana Mucosa , Instrumentos QuirúrgicosRESUMEN
BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but "Downhill Varices" (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications. CASE REPORT: A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass. DISCUSSION: DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS.
RESUMEN
Introducción: la hemorragia digestiva alta (HDA) es una entidad común en gastroenterología, pero las Downhill varices (DHV) son una causa infrecuente de HDA, con diferente etiología de las varices esofágicas de tercio inferior y con diferentes implicaciones terapéuticas. Caso clínico: varón de 28 años de edad, con antecedentes de insuficiencia renal crónica sometido a hemodiálisis y síndrome de vena cava superior(SVCS) debido a múltiples sustituciones catéter, acude a urgencias por hematemesis secundaria a ruptura de una variz en tercio proximal de esófago, que inicialmente se trata con etanolamina. El estudio diagnóstico posterior demostró la circulación colateral secundaria al SVCS. No se pudo realizar terapia endoscópica o endovascular y el paciente finalmente se someterá a un bypass quirúrgico. Discusión: las DHV son una entidad infrecuente y la ligadura endoscópica con bandas se erige como el abordaje terapéutico apropiado para el evento hemorrágico. La terapia definitiva sigue siendo la de la causa del SVCS (AU)
Background: Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but Downhill Varices (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications. Case report: A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass. Discussion: DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS (AU)
Asunto(s)
Humanos , Masculino , Adulto , Várices Esofágicas y Gástricas/sangre , Várices Esofágicas y Gástricas/complicaciones , Várices Esofágicas y Gástricas/diagnóstico , Hemorragia Gastrointestinal/complicaciones , Hemorragia Gastrointestinal/cirugía , Endoscopía/métodos , Angioplastia/instrumentación , Angioplastia/métodos , Várices/sangre , Várices/complicaciones , Trombosis/complicaciones , Trombosis/cirugía , TrombosisAsunto(s)
Enbucrilato/efectos adversos , Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Hemostasis Endoscópica/efectos adversos , Vena Porta , Soluciones Esclerosantes/efectos adversos , Trombosis de la Vena/etiología , Anciano , Enbucrilato/uso terapéutico , Femenino , Hemostasis Endoscópica/métodos , Humanos , Derivación Portosistémica Intrahepática Transyugular , Soluciones Esclerosantes/uso terapéutico , Trombosis de la Vena/terapiaRESUMEN
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