Endoscopic injection therapy for a bleeding exposed vessel in Crohn’s disease - 23/08/11
Doi : 10.1016/j.gie.2008.02.049
| Commentary Severe GI bleeding (SGIB) occurs in about 1% of patients with Crohn’s disease, and although it was said to occur more frequently in those with colonic than with small-intestinal disease, this teaching has become controversial, with some series showing equal distribution of bleeding sites in the ileum and colon. Patients with Crohn’s disease and SGIB tend to be young, although SGIB has been described at all ages, and bleeding may be the index presentation of disease or occur after a long period of stability. It is curious that SGIB does not occur more frequently, because the typical ulcers of Crohn’s disease are deep and it is presumed that SGIB results from erosion of one of these deep ulcers into a large vessel. It also is noteworthy that patients with Crohn’s disease, particularly during disease exacerbation, often have a hypercoaguable state rather than a propensity for GI bleeding. In the era before endoscopy and endoscopic therapy, bleeding was treated by excisional surgery, which seemed to reduce not only mortality but also recurrent bleeding episodes. As the present case shows, identification of the bleeding site and its treatment by a variety of endoscopic means are likely to improve short-term outcome. I doubt the long-term outcome will be primarily improved, but in this case, endoscopic therapy allowed the patient to keep what colon he had and cross the bridge to a trial of immunomodulation. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 68 - N° 3
P. 572-573 - settembre 2008 Ritorno al numero
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