Kotaro Yamaoka

Prevention of recurrent bleeding from gastric ulcer with a nonbleeding visible vessel by endoscopic injection of absolute ethanol : a prospective, controlled trial

We performed a prospective, randomized trial to assess the efficacy of endoscopic injection therapy with absolute ethanol in preventing recurrent bleeding in patients with nonbleeding visible vessels in gastric ulcers. During the period of 1990 to 1993, 62 patients who bled were found to have gastric ulcers with nonbleeding visible vessels; all of them were enrolled for this trial. The 62 patients were randomly divided into two groups, which were comparable at entry. In group I (33 patients), we performed endoscopic injection therapy with absolute ethanol. In group II (29 patients), we sprayed the ulcers with 0.1% epinephrine and thrombin. Endoscopic injection therapy with ethanol was performed at the second endoscopy in the patients in both groups who had recurrent bleeding. Among the 33 patients in group I, 4 patients (12.1%) rebled after the initial ethanol injection therapy, whereas 10 of 29 patients (34.5%) rebled in the control group (p < .05). No patients in group I required surgical intervention, and ultimate hemostasis was achieved in all 33 group I patients (100%), indicating that endoscopic ethanol injection therapy achieves ultimate hemostasis and prevents recurrent bleeding in patients with gastric ulcers and nonbleeding visible vessels.

A case of blue rubber bleb nevus syndrome with familial onset

SummaryWe experienced a case of blue rubber bleb nevus syndrome with familial onset. The patient was a 32-year-old male with a gallstone and many bluish rubber bleb-like hemangiomas on the skin. He suffered from repeated rectal bleeding and underwent a sigmoidectomy at age 17. Gastrointestinal hemangiomas were recognized in the esophagus, stomach, ileum and colon. An angiogram revealed multiple small poolings in the liver, suggesting the presence of hemangiomas. During the cholecystectomy, surgeons noted the presence of hemangiomas on the surface of the liver, serosa of the small intestine and retroperitoneum.Out of 73 blood relatives, 24 also had bluish skin hemangiomas, suggesting them to be inherited by an autosomal dominant trait.More than sixty cases of this syndrome had been reported in the world, eight of which had family histories of skin lesions. However, in only three cases, including our own, was the presence of skin and gastrointestinal hemangiomas recognized.Because the clinical indications for diagnosis of blue rubber bleb nevus syndrome consist of minimal to massive bleeding from the gastrointestinal tract, the possibility that this syndrome is present should be considered when diagnosing a bleeding patient with multiple bluish rubber bleb-like skin lesions, in addition to taking a detailed family history.

Endoscopic Injection of Absolute Ethanol Achieves Ultimate Hemostasis in Bleeding Caused by Peptic Ulcers

Abstract: This study was performed to assess the efficacy of endoscopic injection therapy with absolute ethanol to prevent emergency surgery and recurrent bleeding in patients with peptic ulcers. We compared two different treatment protocols of peptic ulcers with active bleeding or with visible vessels on the ulcer bed. In group I (1981–1984, control group), 45 patients underwent emergency endoscopy with spraying 0.1% epinephrine and thrombin, but no other endoscopic hemostatic procedure. In group II (1989–1992, experimental group), we performed endoscopic injection therapy with absolute ethanol for peptic ulcers in 46 patients. The background characteristics of the patients were not different in the two groups. The rate of successful initial hemostasis tended to be greater in the ethanol injection group compared with the control group without significance. The ultimate hemostatic rate in the ethanol injection group was markedly and significantly greater compared to the control group (P<0.05). Ultimate hemostasis by ethanol injection was performed effectively in peptic ulcers with spurting and oozing hemorrhage and in the non‐bleeding peptic ulcers with visible vessels at the initial endoscopy (P<0.05 for each). These results indicate that ethanol injection therapy by endoscopy achieves ultimate hemostasis and prevents emergency surgery due to hemorrhage from peptic ulcers. (Dig Endoc 1994; 6 : 34–38)