Duodenal Ulcer
Upper Gastrointestinal Bleeding due to a Duodenal Ulcer

Video Endoscopic Sequence 1 of 6.

Upper Gastrointestinal Bleeding due to a Duodenal Ulcer

This a 72 year-old Female, with liver cirrhosis and portal hypertension, who had lost medical supervision until three years ago, In the past, in three sessions the esophageal varices were ligated with bands.

Was hospitalized because of upper GI bleeding. In an emergency endoscopy, finding the esophagus in which there was no varices, observing only the scars. There are traces of blood on the stomach. A duodenal ulcer is located in the anterior wall of the bulb with active bleeding, in which emerges a blood clot.

Upper Gastrointestinal Bleeding due to a Duodenal Ulcer

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All endoscopic images shown in this Atlas contain
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Duodenal Ulcer with active bleeding which emerges a blood clot.

Video Endoscopic Sequence 2 of 6.

Duodenal Ulcer with active bleeding which emerges a blood clot.

At endoscopy the exact site of bleeding is identified.

We previously recommended proton pump inhibitors (PPIs) prescribed permanently for prevention of an ulcer, but the patient had previously suspended, these would have prevented this event.

Endoscopic therapy reduces the recurrence of bleeding from actively bleeding peptic ulcers and those with visible vessels. However, the use of endoscopic therapy for ulcers with adherent clots remains controversial.

In patients with GI bleeding caused by gastric or duodenal ulcers with an adherent clot found on endoscopy, endoscopic therapy with injection of the base of the clot, clot removal, and heat probe coagulation significantly reduces the rate of recurrent bleeding compared with medical therapy alone.

 

 

 

Duodenal Ulcer with active bleeding

Video Endoscopic Sequence 3 of 6.

Another image of Duodenal Ulcer with active bleeding which emerges a blood clot.

Since the late 1980s, endoscopic hemostatic therapy has been widely accepted as the first-line therapy for upper-gastrointestinal bleeding. Numerous clinical trials and two meta-analyses have confirmed the efficacy of endoscopic therapy in this setting. Most clinical trials demonstrated a reduction in both recurrent bleeding and the need for surgical intervention when endoscopic hemostasis was used.

Endoscopic therapy can be broadly categorized into injection therapy, thermal coagulation, and mechanical hemostasis. When analyzed separately, injection therapy, thermal-contact devices, and laser treatment all decrease the frequency of recurrent bleeding and rate of surgical intervention.

 

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Duodenal Ulcer with active bleeding

Video Endoscopic Sequence 4 of 6.

The therapy was iniciated with absolute alcohol injections infiltration around the ulcer.

Rebleeding following epinephrine injection of bleeding peptic ulcers occurs in 10% to 20% of all cases. The addition of a sclerosant has the theoretical advantage of inducing vessel thrombosis and permanent hemostasis.

Duodenal Ulcer with active bleeding

Video Endoscopic Sequence 5 of 6.

An approach to the region of the duodenal ulcer, where therapy was performed with absolute alcohol injections, noting areas where infiltrations were performed of white color.

 

Duodenal Ulcer with active bleeding

Video Endoscopic Sequence 6 of 6.

There was no recurrent bleeding.

Recommending the patient permanently using pump inhibitors (PPI) due to liver cirrhosis. This recommendation had been set aside previously.

 

 

Multiple Duodenal Ulcers.

Video Endoscopic Sequence 1 of 3.

Multiple Duodenal Ulcers.

A 59 year-old female, with portal hypertension, jaundice. and esophageal varices grade I-II. The images and videos display several duodenal ulcers and erosions with yellowish color due to jaundice.

 

 

 

 

Multiple Duodenal Ulcers.

Video Endoscopic Sequence 2 of 3.

Multiple Duodenal Ulcers.

The ulcers are from the duodenal bulb to the third portion of the duodenum, Multiple; variable in size, shallow erosions some with black necrotic bases are observed.

 

Multiple Duodenal Ulcers.

Video Endoscopic Sequence 3 of 3.

Multiple Duodenal Ulcers.

The papilla of Vater is observed ulcerated. 

 

Erosive Duodenitis And Duodenal Ulcer

Video Endoscopic Secuence 1 of 3.

Erosive Duodenitis And Duodenal Ulcer

An 85 year-old male, with hepatic cirrhosis and varices of the esophagus.
Enormous duodenal ulcers and erosions are seen. The patient suffered a gastrointestinal hemorrhage.

 

Erosive Duodenitis And Duodenal Ulcer

Video Endoscopic Secuence 2 of 3.

Erosive Duodenitis And Duodenal Ulcer

Several duodenal ulcers are seen some with necrotic borders.

 

scar tissue due to the previous ulcers.

Video Endoscopic Sequence 3 of 3.

One and a half year after, an upper endoscopy was performed and some polypoid structures was found that belong to scar tissue due to the previous ulcers. Patient since the hemorrhage has been under lanzoprazol treatment 30 mg every day.

 

Brunner's gland hyperplasia.

Video Endoscopic Sequence 1 of 3.

Brunner's gland hyperplasia.

 

Video Endoscopic Sequence 2 of 3.

Brunner's gland hyperplasia.

This image and the video clip are appreciated using a magnifyng endoscope.

 

Endoscopy of Brunner's gland hyperplasia.

Video Endoscopic Sequence 3 of 3.

Endoscopy of Brunner's gland hyperplasia.

This image and the video clip is appreciated using a magnifyng endoscope.
Johann Conrad Brunner, 1653–1727, Swiss anatomist, hypertrophy of tubuloalveolar glands in the submucosal layer of the duodenum. They are most numerous in the duodenal bulb proximal to the pyloric canal and their number decreases gradually in the second and third part of the duodenum. They are not usually present in the jejunum or the ileum. It has been reported that their number increases in patients with cystic fibrosis, uraemia and Zollinger Ellison syndrome. Hyperplasia of Brunner’s glands probably represents a response of the duodenal mucosa to peptic ulcer disease.

Brunner's gland hyperplasia.

Video Endoscopic Sequence 1 of 5.

Brunner's gland hyperplasia.

This image and the video clip have been observed with a magnifying endoscope.
Hyperplasia of Brunner´s glands with sign of micro hemorrhage.

 

Brunner's gland hyperplasia.

Video Endoscopic Sequence 2 of 5.

Brunner's gland hyperplasia.

Nodular duodenum, frequently described as nodular duodenitis, is endoscopically characterized by multiple erythematous nodules in the proximal duodenum and may represent a variant of duodenal inflammation.

 

Video Endoscopic Sequence 3 of 5.

Brunner's gland hyperplasia.

High magnification with Chromoendoscopy.
Using methylene blue stain.

 

Brunner's gland hyperplasia.

Video Endoscopic Sequence 4 of 5.

Brunner's gland hyperplasia.

For more endoscopic features download the video clip
by clicking on the image.

 

Brunner's gland hyperplasia.

Video Endoscopic Sequence 5 of 5.

Brunner's gland hyperplasia.

For more endoscopic features download the video clip
by clicking on the image.

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