PDF(Pubmed)
Abstract：
BACKGROUND: Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual, difficult to treat, and often fatal manifestation of portal hypertension. So far, no treatment guidelines have been established.
METHODS: We reported three patients with jejunal varices at the site of choledochojejunostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023. We reviewed all patient records, clinical presentation, endoscopic findings and treatment, outcomes and follow-up. Three patients who underwent pancreaticoduodenectomy with a Whipple anastomosis were examined using conventional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop. Varices with stigmata of recent hemorrhage or active hemorrhage were observed around the choledochojejunostomy site in all three patients. Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients. The bleeding ceased and patency was observed for 26 and 2 months in two patients. In one patient with multiorgan failure and internal environment disturbance, rebleeding occurred 1 month after endoscopic sclerotherapy, and despite a second endoscopic sclerotherapy, repeated episodes of bleeding and multiorgan failure resulted in eventual death.
CONCLUSIONS: We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection can be an easy, effective, safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.
METHODS: We reported three patients with jejunal varices at the site of choledochojejunostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023. We reviewed all patient records, clinical presentation, endoscopic findings and treatment, outcomes and follow-up. Three patients who underwent pancreaticoduodenectomy with a Whipple anastomosis were examined using conventional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop. Varices with stigmata of recent hemorrhage or active hemorrhage were observed around the choledochojejunostomy site in all three patients. Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients. The bleeding ceased and patency was observed for 26 and 2 months in two patients. In one patient with multiorgan failure and internal environment disturbance, rebleeding occurred 1 month after endoscopic sclerotherapy, and despite a second endoscopic sclerotherapy, repeated episodes of bleeding and multiorgan failure resulted in eventual death.
CONCLUSIONS: We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection can be an easy, effective, safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.
摘要：
背景：胆总管空肠吻合术部位与静脉曲张相关的出血并不常见，难以治疗,通常是门静脉高压症的致命表现。到目前为止,尚未制定治疗指南.
方法：我们报告了在2021年6月至2023年8月期间在我们机构接受内镜下硬化治疗并注射聚桂醇/α-氰基丙烯酸丁酯的3例胆总管空肠吻合术部位出现空肠静脉曲张的患者。我们查看了所有的病人记录,临床表现,内镜检查结果和治疗，结果和后续行动。使用常规上消化道内窥镜检查对三名接受胰十二指肠切除术并进行Whipple吻合术的患者进行了检查，以怀疑来自传入空肠loop的出血。在所有三名患者中，在胆总管空肠吻合术部位周围均观察到静脉曲张伴近期出血或活动性出血。对所有三名患者在空肠静脉曲张进行了内窥镜注射聚桂醇/α-氰基丙烯酸丁酯。在两名患者中，出血停止，通畅持续26个月和2个月。在一名患有多器官功能衰竭和内部环境紊乱的患者中，内镜硬化治疗后1个月再出血,尽管进行了第二次内窥镜硬化治疗，反复出血和多器官功能衰竭导致最终死亡.
结论：我们得出的结论是，聚桂醇/α-氰基丙烯酸丁酯注射液的内镜硬化治疗是一种简单的治疗方法，有效,胆总管空肠吻合术部位空肠静脉曲张出血的安全和低成本治疗选择。
方法：我们报告了在2021年6月至2023年8月期间在我们机构接受内镜下硬化治疗并注射聚桂醇/α-氰基丙烯酸丁酯的3例胆总管空肠吻合术部位出现空肠静脉曲张的患者。我们查看了所有的病人记录,临床表现,内镜检查结果和治疗，结果和后续行动。使用常规上消化道内窥镜检查对三名接受胰十二指肠切除术并进行Whipple吻合术的患者进行了检查，以怀疑来自传入空肠loop的出血。在所有三名患者中，在胆总管空肠吻合术部位周围均观察到静脉曲张伴近期出血或活动性出血。对所有三名患者在空肠静脉曲张进行了内窥镜注射聚桂醇/α-氰基丙烯酸丁酯。在两名患者中，出血停止，通畅持续26个月和2个月。在一名患有多器官功能衰竭和内部环境紊乱的患者中，内镜硬化治疗后1个月再出血,尽管进行了第二次内窥镜硬化治疗，反复出血和多器官功能衰竭导致最终死亡.
结论：我们得出的结论是，聚桂醇/α-氰基丙烯酸丁酯注射液的内镜硬化治疗是一种简单的治疗方法，有效,胆总管空肠吻合术部位空肠静脉曲张出血的安全和低成本治疗选择。
