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PubMed1991

Evaluation of atropine, glucagon, and metoclopramide for facilitation of endoscopic intubation of the duodenum in dogs.

Modification of gastroduodenal motility has been proposed to aid endoscopic examination of the duodenum in dogs. The objective of this study was to evaluate the use of the following pharmacologic agents for facilitation of endoscopic intubation of the duodenum in 6 clinically normal dogs: metoclopramide HCl (0.2 mg/kg of body weight), atropine sulfate (0.045 mg/kg), glucagon (0.06 mg/kg), and isotonic saline solution. In a randomized, blinded, crossover design, the ease of endoscopic duodenal intubation was qualitatively scored by 3 endoscopists (in random order), using the following scale: 1 - immediate entry; 2 - rapid entry--moderate manipulation; 3 - difficult entry--multiple attempts; and 4 - no entry after 2 minutes [corrected]. Anesthesia was induced with thiopental and maintained with halothane. The 4 agents were diluted to a fixed volume and randomly administered. Duodenal intubation was attempted 2 minutes after IV injection of 1 of the agents. Four endoscopic procedures (1 for each agent) were performed on each dog with a minimum of 5 days between each procedure. In this study, no agent facilitated endoscopic duodenal intubation at the dose used. Instead, atropine and metoclopramide made duodenal intubation significantly more difficult, compared with use of saline solution. Difference between intubation after administration of glucagon and saline solution was not seen. On the basis of our findings, the use of these agents for facilitating endoscopic duodenal intubation is not recommended. In addition, in this study, we found that experience in endoscopic intubation is an important factor in determining the ease of duodenal intubation.

Animals↗
PubMed1991

Techniques for endoscopic obliteration of esophageal varices.

Endoscopic treatment is widely accepted for both initial and subsequent definitive therapy in patients with hemorrhage from esophageal varices. Endoscopic sclerotherapy, once performed with rigid endoscopes in anesthetized patients, is now performed with flexible endoscopes in awake patients, who frequently return home immediately after the procedure. Such treatment does not confer a survival advantage in the early period after variceal hemorrhage, but serial treatment does result in a lower risk of recurrent hemorrhage and probably prolongs life. Primary treatment by endoscopic sclerotherapy appears to be equal or more effective than primary shunt therapy, even with a sclerotherapy failure rate of from 10 to 30 percent. In spite of such results, the incidence of rebleeding and treatment-related complications and the mortality among sclerotherapy-treated patients remain high. Newer forms of endoscopic treatment such as polymer injection and mechanical ligation have emerged in attempts to better the results obtained with sclerotherapy. Refinement of the technique for conventional sclerotherapy and the potential for increased effectiveness of the new techniques may yet result in improved and safer endoscopic therapy for bleeding esophageal varices.

Embolization, Therapeutic↗
PubMed1990

[Immediate and long-term results of endoscopic or surgical Oddi sphincterotomy in the treatment of lithiasis of the common bile duct].

Ninety-one patients with choledocholithiasis were admitted for endoscopic (51 cases) or surgical (40 cases) sphincterotomy of Oddi's muscle, and were followed up on a yearly basis thereafter for a period spanning 1 to 5 years. The study protocol included clinical examinations, ultrasonographic investigations and biochemical tests. The post-surgery mortality rate was 3.9% following endoscopic sphincterotomy versus 0% after surgery. Postoperative complications occurred in 3.9% of patients treated endoscopically (bleeding, angiocholitis) and in 5% of surgical patients (bronchopneumonia, suppuration of abdominal wall). Attempts to remove calculi via endoscopic Oddian sphincterotomy failed in 37% of cases. Long-range results were classified as excellent or good in 92% of patients treated endoscopically, and in 100% of cases treated surgically. Endoscopic division of Oddi's sphincter was unsuccessful in 4 patients (8%), who either had recurrent bile-duct stones (2 cases) or developed sphincteric stenosis. Among biochemical indices of biliary stasis, only alkaline phosphatase contents showed a greater increase following endoscopic sphincterotomy than after surgical treatment. Ultrasonographic studies of the bile duct evidenced a greater incidence of air entrapment in the bile ducts of patients subjected to surgical sphincterotomy.

Adult↗
PubMed1988

[Changes in the ileal mucosa in Crohn disease. Endoscopic and histologic study].

In 383 patients, suffering from Crohn's disease, ileum was studied both endoscopically and histologically. In patients without surgical interventions (n = 207), endoscopic lesions were observed in 69%, histologic lesions in 74%. Most numerous endoscopic lesions were redness (51%), vulnerability (29%) and ulcer (27%), most frequent histologic lesions discontinuous infiltration (30%) and ulcer (30%). In patients, operated on, endoscopic and histologic lesions were found more often in the ileal region, near to anastomosis than in the more proximal ileum. Overall, the endoscopic and histologic appearance of the distal segment of the ileum widely corresponded to that of the terminal ileum in patients without surgery. Several endoscopic parameters were correlated to histologic variables, but overall the correlation was low (maximal correlation coefficient 0.34). Granulomas were present in 7.4% of the biopsies and 9.1% of the patients. The occurrence was significantly correlated to the endoscopic variables cobblestone appearance and ulcer as well as to the histologic variables density of infiltration, ulcer, and activity of inflammation. In conservatively treated patients, the incidence of mucosal vulnerability, and cobblestone appearance significantly declined in long standing disease, the incidence of stenosis increased. In patients operated on, aphthous lesions and ulcers increased in longstanding disease.

Adolescent↗
PubMed1986

A comparison of endoscopic suspension of the vesical neck versus anterior urethropexy for the treatment of stress urinary incontinence.

Endoscopic suspension of the vesical neck has been reported to be as effective as anterior urethropexy in the treatment of female stress urinary incontinence. We compared our first 29 patients treated with endoscopic suspension of the vesical neck between 1982 and 1985 to our last 21 patients treated with anterior urethropexy between 1979 and 1985. Both groups were comparable in regard to age, parity, duration of symptoms and previous surgery for stress urinary incontinence. All patients underwent thorough preoperative urodynamic testing. Endoscopic suspension of the vesical neck successfully cured stress urinary incontinence in 26 patients (90 per cent), while anterior urethropexy resolved the incontinence in 20 (95 per cent). Of the 3 failures of endoscopic suspension 2 probably were related to technique or material failure. Hospitalization was reduced for endoscopic suspension versus anterior urethropexy (mean 4.04 versus 6.00 days, respectively). The most common complication after endoscopic suspension of the vesical neck was transient urinary retention (34 per cent). We conclude that endoscopic suspension of the vesical neck is an effective method to treat stress urinary incontinence, and that it also reduces hospital stay and postoperative recovery.

Endoscopy↗
PubMed1986

Comparison of percutaneous endoscopic gastrostomy with surgical gastrostomy at a community hospital.

The results of percutaneous endoscopic gastrostomies in 100 patients in a community hospital were compared with those of surgically placed gastrostomies in 50 patients. The morbidity rate for the percutaneous endoscopic gastrostomy group was 4%, compared with 30% for the patients with surgically placed gastrostomies. The procedure-related mortality for percutaneous endoscopic gastrostomy was 1%, compared with 16% for surgically placed gastrostomies. Patients admitted to the hospital for percutaneous endoscopic gastrostomy stayed an average of 4 days compared with 10 days for the surgical patients; 14 patients had the percutaneous endoscopic gastrostomy performed as an outpatient procedure. There were no complications in this group, suggesting that percutaneous endoscopic gastrostomy can be safely performed as an outpatient. In this community hospital, percutaneous endoscopic gastrostomy was both substantially safer and far less expensive than surgically placed gastrostomy.

Aged↗
PubMed1985

[Acute secondary pseudo-obstruction of the colon (Ogilvie syndrome): experiences with endoscopic therapy].

Twenty-seven patients with acute secondary colonic pseudoobstruction have been studied before and after endoscopic decompression of the colon. 19 patients were treated by single endoscopic decompression and 8 patients who had, or were expected to have, recurrent pseudoobstruction were treated by endoscopy-assisted introduction of a double-lumen tube into the colon. 17 out of 27 patients had massive dilatation of the right hemicolon. 19 patients completely retained stools and had a dilated colon the day before the endoscopic treatment, while 8 out of 27 patients still had passage of stool despite threatening dilatation of the colon. Initial decompression of the colon was achieved in all patients with both techniques, but cecal perforation developed in 1 patient. Normal colonic function returned in all patients who underwent single endoscopic decompression within three days, and in all patients treated with a colonic tube within 4 days (mean value). The success of endoscopic therapy of acute pseudoobstruction could not be explained by drugs administered before and after the endoscopic treatment. It is concluded that endoscopic decompression of the colon is an effective treatment for acute pseudoobstruction. Repeated colonoscopic decompression in refractory cases may be avoided by endoscopy-assisted placement of large caliber drainage tubes.

Aged↗
PubMed1983

Duodenogastric bile reflux as measured by an isotope technique and its correlation with endoscopic findings.

76 patients were examined for duodenogastric reflux by gastroscopy and by a non-invasive isotope method using Tc-99m diethyliminodiacetic acid. The bile acid concentration of endoscopically aspirated gastric juice was measured. The patients with endoscopically diagnosed bile in the stomach (51 patients) had duodenogastric reflux significantly (p less than 0.05) more often in the isotope examination than the patients without bile observed in the stomach (25 patients). The amount of bile as estimated endoscopically correlated well with the bile and acid concentration of gastric juice. However, 18 patients with endoscopic bile reflux had no reflux in the isotope examination and 9 patients without endoscopic bile reflux had a mild reflux isotopically. The reflux estimations made endoscopically tend to give comparable results in general, but in many patients the results entirely differ from those obtained with the isotope method. We suggest that this difference is mainly due to the invasive nature of the endoscopic examination.

Bile Acids and Salts↗
PubMed1995

[Endoscopic and surgical therapy of hemorrhagic duodenal and stomach ulcer].

The aim of this prospective clinical study was to evaluate whether a combination of the endoscopic hemostasis together with fibrin sealing and consecutive conservative therapy could reduce the frequency of recurrent bleedings, thus the number of operations without adversely influencing the prognosis of the disease. 134 patients admitted to the surgical and medical hospital of the University of Ulm between 1/1990 and 1/1992 with bleeding gastroduodenal ulcers took part in this study. All patients were treated endoscopically by hypertonic saline solution plus epinephrine and fibrin sealant. If initial endoscopic hemostasis was not achieved patients were operated within 6 h after admission. Patients with successful initial endoscopic hemostasis were treated conservatively and underwent control endoscopy after 24 and 48 h. In 23 patients the initial endoscopic hemostasis was not successful, they had to be operated immediately. In 111 patients endoscopic hemostasis was achieved, 20% of these patients had acute bleeding ulcers (Forrest Ia, b), 66% showed stigmata of fresh bleedings (Forrest-IIa bleeding). Primary endoscopic hemostasis was achieved in 85.6% of all patients treated, 14.4% of patients (n = 16) developed a recurrent bleeding during the observation period verified by gastroscopy. Half of these patients had an acute bleeding at the first gastroscopy (Forrest-Ia, Forrest-Ib bleeding). Recurrent bleeding became apparent between day 1 and 6 after admission to the hospital. Two patients refused surgical intervention, the other 14 were operated immediately.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Endoscopic treatment of colorectal cancer].

Endoscopic polypectomy should be applied only for early colorectal carcinomas. Intramucosal carcinoma do not have a risk of lymph node metastases. However, there is an about 10% risk of lymph node metastases among carcinomas showing submucosal invasion (sm carcinoma). When risk factors revealed to be positive after polypectomy, subsequent surgical resection of the large bowel with lymph nodes dissection is needed, because these sm carcinomas are considered to have a high risk of lymph node metastases. Therefore, accurate diagnosis of depth of invasion is essential to prevent subsequent surgical resection following endoscopic polypectomy. Endoscopy, barium enema and endoscopic ultrasonography (EUS) are all considered to be effective for an accurate diagnosis of depth of invasion. Endoscopic polypectomy includes hot biopsy, snare polypectomy and endoscopic mucosal resection (EMR). Appropriate maneuver must be chosen, considering the characteristics of the lesion. Major complications after endoscopic polypectomy are bleeding and perforation of the large bowel. Including an establishment of a new risk factors, further efforts must be made to prevent unnecessary additional surgical resection of the large bowel following endoscopic polypectomy.

Aged↗
PubMed1994

Endoscopic sclerotherapy in upper gastrointestinal bleeding due to the Mallory-Weiss syndrome.

OBJECTIVES: Therapeutic endoscopic techniques have changed the need for emergency surgery in gastrointestinal bleeding episodes. However, there is only little information about endoscopic therapies in severe gastrointestinal bleeding due to the Mallory-Weiss syndrome. The aim of this clinical study was to assess the usefulness of early endoscopic examination and sclerotherapy for severe or recurrent bleeding due to the Mallory-Weiss syndrome. METHODS: We studied all 50 cases of gastrointestinal bleeding secondary to the Mallory-Weiss syndrome seen in 2175 consecutive emergency endoscopic examinations performed in a University Hospital over a 3-year period. Endoscopic sclerotherapy (1/10000 adrenaline + 1% polidocanol) was performed in all patients with active bleeding or visible vessel at endoscopic examination. The remaining patients were medically treated. RESULTS: Active bleeding or a visible vessel were found in 13 patients; definitive hemostasis was obtained in all cases with sclerotherapy. The remaining 37 patients were successfully treated by conservative therapy. On admission, the severity of the hemorrhagic episodes was significantly higher in patients treated with sclerotherapy than in those who did not require this procedure. An esophageal perforation, successfully managed by conservative means, was the only complication recorded in the subset of patients undergoing sclerotherapy. CONCLUSIONS: Severe bleeding due to Mallory-Weiss syndrome can be successfully treated by sclerotherapy. Early endoscopic examination is an accurate procedure in identifying patients who do not require sclerotherapy.

Adult↗
PubMed1994

Combined endoscopic and surgical management of Dieulafoy vascular malformation.

BACKGROUND: Dieulafoy's disease (exulceratio simplex) is an uncommon cause of gastric hemorrhage as a result of an abnormally large, submucosal, eroded gastric artery, often located in the upper part of the stomach. It represents a clinical challenge because of the intermittent nature of massive bleeding accounting for a constantly fatal course in conservatively (nonsurgically or nonendoscopically) treated patients. Published therapeutic options include techniques of endoscopic hemostasis or operative procedures. STUDY DESIGN: Herein we report two patients in whom a combined endoscopic and operative approach was performed to obtain a definitive prevention of rebleeding and an undoubted anatomopathologic diagnosis. RESULTS: Our innovative combined endoscopic and operative approach has offered three significant advantages: endoscopic preoperative diagnosis and control of the bleeding; valid aid in the intraoperative localization of hemorrhagic lesions, which is erratic intraoperatively, requires gastrotomy, and prolongs the duration of operation; and endoscopy-guided limited wedge resection as opposed to standard techniques involving gastrotomy for simple ligation or oversewing of the involved vessel, local excision, or wide wedge resections that used to be recommended until the recent past. CONCLUSIONS: We confirm that seemingly obscure origins of massive recurring hemorrhage of the upper part of the gastrointestinal tract should increase the suspicion of Dieulafoy's disease, prompting careful examination of the gastric fundic area and greater curvature. Endoscopic hemostasis is the first choice; whenever operative treatment is indicated (because of the endoscopic or clinical situation), it should be as conservative as possible because of intraoperative endoscopic localization of the bleeding source.

Aged↗
PubMed1993

Assessment of airway inflammation in asthmatic patients by visual endoscopic scoring systems.

Inflammation is a hallmark of bronchial asthma. Inflammatory cells both in bronchoalveolar lavage (BAL) and bronchial biopsies of asthmatic patients have been studied and correlated with functional or clinical parameters. We have recently attempted to assess airway inflammation by a visual endoscopic scoring system. The purpose of this study was to compare our own endoscopic scoring system with the bronchitis index previously described by Thompson and coworkers, and to determine whether these scores were correlated with clinical or functional parameters. Sixty asthmatics of variable severity (forced expiratory volume in one second (FEV1) 33-117% of predicted values) and 30 healthy volunteers were studied. The clinical severity of asthma was assessed by the clinical score as described by Aas in all of the patients, and in the last 15 patients by a daily symptom score. Beta 2-agonist consumption was recorded daily during a period of 7 days before the endoscopic procedure. During this period, circadian variation and day-to-day variation of peak expiratory flow rate (PEFR) were determined. During bronchoscopy, airway inflammation was assessed by two independent observers, prior to BAL, by visual inspection of each lobe and the lingula, and the results were quantitated using the bronchitis index and our endoscopic scoring system. Both endoscopic scores were significantly higher in asthmatics than in controls. A significant correlation was observed between the two endoscopic scores both in asthmatics and in controls. In asthmatics, a weak but significant correlation was found between both endoscopic scores and the daily symptom score, as well as the beta 2-agonist consumption.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Endoscopic ultrasonography in the diagnosis of an early esophageal carcinoma.

Patients with epithelial or mucosal carcinoma of the esophagus are considered to have a much better prognosis than those with submucosal carcinoma, although both lesions are classified as superficial carcinomas of the esophagus. With this in mind, we evaluated the usefulness of endoscopic ultrasonography for pre-operatively distinguishing either epithelial or mucosal carcinoma from submucosal carcinoma by comparing the results of endoscopic ultrasonography with the histological findings established in resected specimens. Between 1987 and 1991, 26 patients with no pre-operative treatment were confirmed histologically to have epithelial (2 cases), mucosal (11 cases) or submucosal (13 cases) carcinomas of the esophagus. In 13 patients with epithelial or mucosal carcinoma, 10 were correctly diagnosed with endoscopic ultrasonography (76.9%), while the remaining 3 were overdiagnosed as being submucosal. In 13 patients with submucosal carcinoma, 12 were correctly diagnosed by endoscopic ultrasonography (92.3%), although another case was overestimated. Including one patient with an advanced carcinoma who was underdiagnosed by endoscopic ultrasonography as having a submucosal lesion, the overall accuracy of endoscopic ultrasonography was 81.5% for diagnosing the depth of invasion of a superficial esophageal carcinoma. The above results show that endoscopic ultrasonography can provide surgeons with important information in the pre-operative assessment of a superficial esophageal carcinoma.

Adult↗
PubMed1996

The relationship between the content of aggressive and protective components in gastric juice and endoscopic findings after naproxen sodium and acetaminophen administration.

OBJECTIVES: To evaluate the diagnostic value of residual gastric juice, we assessed various secretory components before and after placebo, acetaminophen, or naproxen sodium administration. METHODS: In a double-blind, randomized, cross-over study in 30 asymptomatic volunteers, mucin, hydrophobicity, protein, pepsin, and pH were measured in residual gastric juice before and after placebo, naproxen sodium (660 mg/d), or acetaminophen (4000 mg/d) administration. Mucus layer thickness in biopsy specimens was assessed, and mucosal damage was endoscopically evaluated. RESULTS: All parameters were unchanged after 7 days of placebo. Naproxen caused a 46% (p = 0.008) increase in the rate of luminal mucin release, an 18% increase (p = 0.510) in protein release, and a 61% decrease (p = 0.001) in hydrophobicity. Antral and duodenal mucus gel thickness were compromised, and hemorrhagic and erosive endoscopic changes were noted. Acetaminophen resulted only in a significant decline of pepsin. In subjects without endoscopic damage after naproxen, a nonsignificant decrease in hydrophobicity was noted. However, in subjects with endoscopic changes, a 55% decrease (p = 0.002) in hydrophobicity and a 42% increase (p = 0.024) in the rate of luminal mucin release were demonstrated. The initial mucin of subjects who developed endoscopic mucosal changes after naproxen was 53% higher than in subjects without damage. Subjects with endoscopic changes also exhibited a 48% lower initial hydrophobicity and a 43% lower pepsin than subjects without endoscopic changes. CONCLUSIONS: Gastric mucosal damage after naproxen sodium results in profound changes within the gastric mucosal barrier, and analysis of residual gastric juice components adequately reflects these changes. In contrast, acetaminophen results in only minimal gastric juice changes. Analysis of residual gastric juice may be useful in monitoring the extent of mucosal damage and identifying patients likely to develop mucosal damage.

Acetaminophen↗
PubMed1996

Utility of endoscopic ultrasonography with color Doppler function for the diagnosis of islet cell tumor.

OBJECTIVE: To evaluate the efficacy of endoscopic ultrasonography with color Doppler function for the diagnosis of islet cell tumor. METHODS: Endoscopic ultrasonography was compared with other modalities such as ultrasonography, computed tomography, and angiography in the evaluation of seven patients with islet cell tumor and 28 patients with duct cell cancer. RESULTS: In cases of islet cell tumor, the tumor detection rates by ultrasonography and endoscopic ultrasonography were 86% and 100%, respectively. Color signals were detected in 14% and 100% of the cases of islet cell tumor by ultrasonography and endoscopic ultrasonography, respectively. The pattern of color signals obtained was rich and abundant, showing pulsatile and/or continuous wave patterns. Angiography and computed tomography showed hypervascularity. However, in cases of duct cell cancer, the tumor detection rates by ultrasonography and endoscopic ultrasonography were 96% and 100%, respectively, whereas color signals were detected in 78% with both ultrasonography and endoscopic ultrasonography. The image of blood flow, which was connected to surrounding vessels, showed a linear pattern and few blood flow signals. In these cases, angiography and computed tomography demonstrated encasement of the artery or portal vein without hypervascularity. CONCLUSIONS: Endoscopic ultrasonography was usefull for the localization and differential diagnosis of islet cell tumor because of its excellent ability to visualize small lesions and tumor vascularity simultaneously.

Adenoma, Islet Cell↗
PubMed1996

[Endoscopic treatment of gastrointestinal cancers--indication and limitation].

Recently, endoscopic treatments have been applied for the curative treatment of early gastrointestinal cancers and for the palliative treatment of end-stage gastrointestinal cancers. As a curative treatment for early gastric cancers, the endoscopic Nd-YAG laser therapy was initially applied and a satisfactory results were obtained. However, the endoscopic mucosal resection (EMR) is evaluated as the reliable endoscopic treatment for early gastric cancers because curability can be histologically detected by resected specimen. EMR technique is also applied for early esophageal cancers and early flat or depressed colon cancers. EMR-L (EMR with the use of Ligating device) developed by us is mainly practiced in our department. By the use of EMR-L technique. Resectability has been improved compared with 2 channel EMR technique. As the palliation of end-stage gastrointestinal cancers endoscopy recanalization of malignant esophageal stenosis is very effective to improve the patient's QOL. The memorial metallic stent for esophageal stenosis is very useful to keep cavity for a long term after endoscopic recanalization. PEG (percutaneous endoscopic gastrostomy) is also very effective to reduce the symptoms of the patients with peritonitis carcinoma or ileus. In this paper, the present status of curative and palliative endoscopic treatment for gastrointestinal cancers was reported. In recent future, endoscopy will be more widely applied as a less invasive therapeutic procedure for gastrointestinal cancers.

Endoscopy↗
PubMed1996

Diverticular bleeding and the pigmented protuberance (sentinel clot): clinical implications, histopathological correlation, and results of endoscopic intervention.

UNLABELLED: Over a 3-yr period, we performed colonoscopy on five patients (mean age 71 yr) in whom a specific diverticulum that contained a pigmented protuberance (PiP) was unequivocally identified as the cause for hemorrhage. Four of these individuals had endoscopic bipolar cauterization of the PiP, and two patients had surgery. AIM: To (1) determine the clinical significance of an intradiverticular PiP, (2) correlate endoscopic features of a PiP with histopathological findings and, (3) assess results of endoscopic treatment for affected patients with lower GI bleeding. METHODS: Medical charts were reviewed to garner data and assess outcome for patients. The bleeding diverticulum in one surgical case was detected in the resected specimen, and histological examination was performed. RESULTS: The mean number of transfusions, bleeding days, and lowest hemoglobin concentration before definitive treatment was 4.8, 3.4, and 8.4 gm%, respectively. All patients rebled before treatment. In all instances, the PiP projected through the neck of the diverticulum, which was actively bleeding in two patients. Endoscopic bipolar cautery directed at the PiP achieved permanent hemostasis in three of four subjects (75%) (morbidity 0%). Endoscopic therapy failed in one subject, and a hemicolectomy was performed. Histological evaluation of the resected specimen showed erosion of a medium sized artery into the diverticulum. The PiP represented a sentinel clot (not a visible vessel) adherent to a breach in the vessel wall. A patient who had surgery instead of endoscopic therapy had a prolonged, complicated postoperative course. CONCLUSIONS: (1) The presence of an intradiverticular PiP may identify a subset of patients at risk for severe recurrent diverticular bleeding. (2) Histopathological analysis showed the PiP to be a sentinel clot rather than a visible vessel. (3) In patients with severe recurrent diverticular bleeding, endoscopic treatment of the vessel beneath this lesion may be a viable alternative to surgery.

Aged↗