1. Use of the Ella Danis stent in esophageal bleeding due to severe reflux esophagitis
- Author
-
Gerd Bodlaj, Marion Gamsjäger, Adrian Heghedus, and Heinrich Resch
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Forceps ,Esophageal Diseases ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Esophagus ,Medicine ,Humans ,Reflux esophagitis ,Esophagitis, Peptic ,Aged ,business.industry ,Gastroenterology ,Stent ,Clipping (medicine) ,medicine.disease ,Hemostasis, Surgical ,Surgery ,Esophageal Ulcer ,medicine.anatomical_structure ,Treatment Outcome ,Hemostasis ,030211 gastroenterology & hepatology ,Female ,Stents ,Radiology ,Esophagoscopy ,business ,Gastrointestinal Hemorrhage ,Esophagitis - Abstract
A 79-year-old woman presented with hematemesis. As upper gastrointestinal tract bleeding was suspected, acute gastroduodenoscopy was performed. This showed reflux esophagitis with multiple ulcerations (Los Angeles classification grade D) and oozing hemorrhage (Forrest Ib) in the lower third of the esophagus (●" Fig.1a). The bleeding was originating from a large area of ulceration, so clipping or injection of epinephrine would have been associated with a risk of causing further bleeding. We therefore decided to place an Ella Danis stent (flare diameters, 30mm; body diameter, 25mm; length, 135mm; EllaCS, Hradec Kralove, Czech Republic). After the stent had been expanded, the hemorrhage stopped immediately (●" Fig.1b). The stent stayed in place as a result of its expansion forces; no anchor or clipping was needed. Hemostasis was maintained during the following days. After 5 days, the stent was carefully removed with a forceps without using an overtube. There was considerable improvement in the esophageal appearance with no signs of active bleeding. The vascular stump that had previously bled could still be seen (●" Fig.1c). Two days later the patient was discharged without any further complications. The use of stents for esophageal bleeding was originally reported for acute variceal hemorrhage when endoscopic band ligation could not be performed or was unsuccessful [1,2]. More recently it has been used to treat bleeding from an esophageal ulcer after endoscopic band ligation [3]. Other publications have reported the successful off-label use of the Ella Danis stent in bleeding due to complications after mucosectomy or sphincterotomy, necrotizing esophagitis, as well as in anastomotic leakage [3–5]. So far, there are no data available concerning the safe application of an Ella Danis stent in acute hemorrhage due to severe reflux esophagitis. As there is not sufficient data on efficacy, safety, and complications, further investigation is needed; however, the Ella Danis stent appears to be a promising tool in the endoscopic treatment of a broad spectrum of causes of acute nonvariceal esophageal bleeding.
- Published
- 2016