Video Endoscopic Sequence 1 of 14.

Severe Upper GI Bleeding due to a Duodenal Ulcer

A 51-year-old male, who presented with severe upper digestive system bleeding, manifested with hematemesis and melena and signs of hypotension of two hours of evolution, was referred to our endoscopic unit where inmediately underwent endoscopy finding bled in the gastric chamber and active bleeding in the duodenal bulb where is the exact site is located an ulcer of the duodenum with a thick blood clot with a pulsating active vessel. The video clip shows bright red bleeding.

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Todas las imágenes endoscópicas de este atlas contienen un video.

Video Endoscopic Sequence 2 of 14.

Endoscopy of a bleeding Duodenal Ulcer

There is bright red blood in the duodenum

Video Endoscopic Sequence 3 of 14.

Active bleeding is seen through the pylorus coming from the duodenal bulb.

Video Endoscopic Sequence 4 of 14.

The image and video clip shows an ulcer with active bleeding.

Acute gastrointestinal (GI) bleeding is a potentially life-threatening abdominal emergency that remains a common cause of hospitalization.

The underlying mechanisms of nonvariceal bleeding involve either arterial hemorrhage, such as in ulcer disease and mucosal deep tears, or low-pressure venous hemorrhage, as in telangiectasias and angioectasias. In variceal hemorrhage, the underlying pathophysiology is due to elevated portal pressure transmitted to esophageal and gastric varices and resulting in portal gastropathy.

Video Endoscopic Sequence 5 of 14.

Endoscopy of Bleeding Duodenal Ulcer, A thick clot with a pulsatile blood vessel is observed.

Video Endoscopic Sequence 6 of 14.

infiltration with absolute alcohol therapy is being performed

Endoscopic therapy should be provided to patients with active spurting or oozing bleeding or a non-bleeding visible vessel.

Endoscopic therapy may be considered for patients with an adherent clot resistant to vigorous irrigation. Benefit may be greater in patients with clinical features potentially associated with a higher risk of rebleeding (e.g., older age, concurrent illness, inpatient at time bleeding began) (Conditional recommendation).

Endoscopic therapy should not be provided to patients who have an ulcer with a clean base or a flat pigmented spot (Strong recommendation).

Endoscopic therapy should be provided to patients with active spurting or oozing bleeding or a non-bleeding visible vessel.

Video Endoscopic Sequence 7 of 14.

Note: We have very good experience in managing bleeding ulcers of the duodenum using absolute alcohol infiltrations, since many authors use infiltrations with adrenaline, and do not use alcohol for fear of a perforation, however we have never had such a complication, But it is not bad idea to place hemoclip later, to avoid such complication, it is also necessary to reflect that bleeding with blood vessels of great caliber may not go to give way with adrenaline and if with alcohol.

Video Endoscopic Sequence 8 of 14.

In this image as well as in the video clip, it is observed that the bleeding is continuing with fresh blood there is a thick blood clot with a pulsatile vessel.

Video Endoscopic Sequence 9 of 14.

The pulsatile blood vessel and bright red blood emerging from the ulcer are seen. The therapeutic action is followed.

The infiltrations of absolute alcohol is repeated, Stopping bleeding.

Video Endoscopic Sequence 10 of 14.

Final status of the therapy, There was no re bleeding

In the image and video the ulcer is observed, immediately after the injections of alcohol.

Video Endoscopic Sequence 11 of 14.

Second-look endoscopy, in which repeat endoscopy is performed 48 hours.

Video Endoscopic Sequence 12 of 14.

On the second day of the therapeutic procedure, a new endoscopy is performed, observing the post-treatment status. And 4 duodenal bulb ulcers.

Video Endoscopic Sequence 13 of 14.

More images of the status after endoscopic treatment.

A second endoscopy is often performed in order to evaluate the efficacy of the first injection therapy in patients with duodenal ulcer or bleeding gastric peptic ulcer.

Video Endoscopic Sequence 14 of 14.

It is recommended that all visible vessels of peptic ulcers, whether or not they show bleeding, should be treated by the hemostatic endoscopic procedure, if possible at the first endoscopy.

Video Endoscopic Sequence 1 of 2.

Multiple Duodenal Ulcers

56-year-old male, who suffers from liver cirrhosis and varices of the esophagus.

Video Endoscopic Sequence 2 of 2.

Multiple Duodenal Ulcers

There are several ulcers and erosions, in patients with liver cirrhosis it is common to see this type of multiple ulcerations of the duodenum.