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- W2912963722 abstract "Through-the-Scope (TTS) endoscopic Doppler ultrasound probe technology is a tool that has garnered interest for the evaluation of variceal and non-variceal bleeding. We describe two cases in which endoscopic Doppler probe guided diagnosis and management of two patients with upper gastrointestinal hemorrhage. A 55 year old African American male with history of nephrectomy for a T1N0M0 renal cell carcinoma,end stage renal disease on hemodialysis presented to the emergency department after an episode of melena.Hemoglobin on presentation was 7.1 g/dl. During the hospitalization,he underwent several endoscopies and tagged RBC scan, none of which could identify a source of bleeding.EUS was performed to assess the gastric fundus for gastric varices or gastric Dieulafoy, which was unremarkable.Endoscopy with Doppler probe was subsequently performed and identified a 2 mm. red spot in the duodenal bulb with strong arterial signal compatible with a duodenal Dieulafoy lesion,which was successfully treated.The patient did not have further episodes of bleeding and hemoglobin stabilized at 8 g/dl. A 32 year old male with recent history of binge drinking and emesis presented with gastrointestinal bleeding.On arrival, the patient was hemodynamically stable.Laboratory values were significant for hemoglobin of 13.5 g/dl and platelets of 88 x109/L.On initial endoscopic evaluation, a Mallory-Weiss tear was seen and thought to be the etiology of bleeding.Further evaluation with endoscopic Doppler US probe revealed an audible venous Doppler signal that was consistent with a varix, and closer endoscopic inspection revealed a junctional gastroesophageal varix with a tear.Three bands were successfully placed and post-band ligation Doppler signal was absent. In summary, we present two patients in whom a TTS endoscopic Doppler ultrasound probe guided the diagnosis and subsequent management of acute upper gastrointestinal hemorrhage.In the first patient,it helped to identify an obscure source of GI bleeding after multiple endoscopies and a bleeding scan.In the second patient,it served to discover an unsuspected bleeding etiology of a junctional varix when a Mallory-Weiss tear was initially suspected which then resulted in change of clinical management.Though the literature has identified its utility in peptic ulcer hemorrhage,these cases highlight its use in other causes,which may translate to downstream effects, such as decreasing morbidity and mortality related to GI hemorrhage.Figure: Case One: Two mm red spot in duodenal bulb (arrow), seen during repeat EGD on day 6.Figure: Case Two: Initial endoscopy showing a tear around GE junction (arrow), thought to represent Mallory- Weiss tear.Figure: Case Two: Junctional varix post-band ligation." @default.
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- W2912963722 date "2017-10-01" @default.
- W2912963722 modified "2023-10-16" @default.
- W2912963722 title "Endoscopic Doppler Probe in the Diagnosis and Management of Upper Gastrointestinal Hemorrhage" @default.
- W2912963722 doi "https://doi.org/10.14309/00000434-201710001-01843" @default.
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