Search

Introduction: Endoscopic injection therapy of epinephrine is safe and effective in the treatment of bleeding peptic ulcer, but with high risk of rebleeding. The combination therapy of epinephrine and hemoclips could lead to a reduction of rebleeding and a potential reduction in mortality., Objective: To investigate the efficacy and safety of epinephrine injection therapy and combination therapy with epinephrine and hemoclips in treating bleeding peptic ulcers., Methods: A prospective randomized study included 58 patients with bleeding gastric or duodenal ulcer. In 30 patients endoscopic injection therapy with diluted epinephrine was applied (group I), while in 28 patients combination therapy of epinephrine and hemoclips was applied (group II). RESULTS; Initial haemostasis was achieved in most patients treated with epinephrine injection therapy (93.3%) and patients treated with combination therapy of epinephrine and hemoclips (96.4%). After initial haemostasis was achieved rebleeding was significantly more frequent in the patients treated with epinephrine (28.5%) than in the patients treated with combination therapy (3.7%, p < 0.05). Two patients treated with epinephrine injection therapy were subjected to surgical intervention, whereas no patient treated with combination therapy needed surgery. Lethal ending occurred in one patient treated with epinephrine and in one patient treated with combination therapy. The difference between the two groups of patients in need for surgical intervention and mortality was not statistically significant., Conclusion: Combination therapy with epinephrine and hemoclips is more efficient than epinephrine alone in the treatment of bleeding peptic ulcers.

Introduction: The most frequently applied methods of endoscopic treatment of angiodysplasias, such as argon plasma coagulation, multipolar coagulation and heater probe, proved to be effective with certain shortcomings and the possibility of complications. There are very scarce data in the literature about the treatment of angiodysplasias with endoscopic ligature., Objective: The aim of the study was to examine the efficacy and safety of endoscopic treatment of gastric and duodenal angiodysplasias by ligation with elastic rings., Methods: In 12 patients (10 male and 2 female, mean age 65.9 years) the endoscopic ligation of gastric and duodenal angiodysplasias was applied. Eight patients (66.6%) had solitary angiodysplasias in the stomach, two patients (16.6%) had solitary angiodysplasias in the descending part of the duodenum and two patients (16.6%) had multiple angiodysplasias in the stomach and duodenum.Two patients (16.6%) had active bleeding from angiodysplasias, while 10 patients (83.3%) had recent bleeding. We used the Cook Endoscopy system with 4 or 6 elastic rings for endoscopic ligation of angiodysplasias. Patients were under follow-up after 2-3 days, 30 days and then every 6 months following the endoscopic ligation of angiodysplasias., Results: Active bleeding from angiodysplasias was stopped in two patients (100%) by endoscopic ligation with elastic rings. The average number of applied ligation sessions in our 12 patients was 1.6, with an average of 1.8 ligatures per session. There were no complications after ligation of angiodysplasias. Recurrence of bleeding occurred in one patient (8.3%) with multiple gastric and duodenal angiodysplasias.The average period of follow-up of patients was 22.8 +/- 17.6 months., Conclusion: Endoscopic ligation with elastic rings can be effective and safe for treatment especially of solitary gastric and duodenal angiodysplasias.

Background: Meckel's diverticulum (MD) is a congenital anomaly of the small intestine. It results from incomplete obliteration and resorption of the proximal omphaloenteric duct connecting yolk sac with primitive gut in the fetal period., Case Report: A case of 20-year old female with ectopic pancreatic rests in a MD was reported. She was hospitalized with clinical signs of acute appendicitis. During surgery an inflamated Meckel's diverticulum was found and a clinoid resection of the diverticulum was performed. Histologic examination revealed pancreatic tissue in the removed diverticulum. Endocrine cells (EC) were detected with Masson staining and aberrant pancreatic tissue with immunocytochemical LSAB2 method using pan cytokeratin as epithelial marker., Conclusion: Most of MD are asymptomatic and accessory finding during laparothomias for different causes, but complications of undiagnozed MD can be serious (diverticulitis, perforation with peritonitis or intestinal obstruction caused by invagination). In unclear cases, additional cytochemical and immunocytochemical diagnostics could be done.