(1) Injection therapy: It is the simplest treatment. As early as 1970s, people tried to inject 1% ethoxylated alcohol under endoscope. After local injection, mucosal edema increases the pressure around the bleeding focus, compresses the blood vessels and promotes the formation of intravascular thrombosis. Injection of adrenaline can also make local blood vessels contract, thus achieving the purpose of hemostasis. Injection method: routine endoscopic examination found the bleeding focus and fully exposed the bleeding site, and sent it to the endoscopic injection needle through the endoscopic biopsy hole. At the same time, the selected drugs were first injected into the endoscopic needle tube at a distance of/~ 2~3mm from the bleeding blood vessel/kloc-0, and injected at 3 ~ 5 points with a depth of 2 ~ 3 mm to effectively blacken fresh blood, then the blood clot was washed with ice water, and supplementary injections were made when necessary. Commonly used drugs are:
① Absolute ethanol: each point should be 0. 1 ~ 0.2 ml, and the total amount is 1 ~ 2 ml.
② Hardener: 5% sodium morrhuate or 1% ethoxylated alcohol, 0.2 ~ 0.5 ml per point, with a total amount of 2 ~ 4 ml.
③ Hypertonic sodium epinephrine solution (HSE): 0.5ml per point, with the total amount not exceeding 10ml. The adverse reaction of injection of sclerosing agent and anhydrous ethanol is ulcer formation, so pay attention to dosage and depth.
(2) Thermoprobe Coagulation Therapy: Thermoprobe Coagulation Hemostasis is to insert a special thermoprobe into the stomach through the endoscopic biopsy channel, and directly contact with the bleeding focus, so that protein can coagulate and stop bleeding. Under the direct vision of endoscope, aim the thermal probe at the bleeding focus and wash the blood clot on the surface of the lesion with water. Then the thermal probe is gently pressed on the bleeding focus and thermally coagulated. After the color of the diseased tissue fades, water is injected to cool the probe to separate it from the coagulated tissue. If there is still bleeding, it can be repeated several times until the bleeding stops. Observe for a few minutes after stopping bleeding, and when it is determined that there is no more bleeding, you can exit the endoscope. Thermal probe coagulation hemostasis method is simple, effective and safe, and the instrument price is much lower than that of laser.
(3) Microwave coagulation therapy: Endoscopic microwave coagulation therapy is a therapeutic method that concentrates microwave energy in a small area to coagulate tissue proteins and achieve the purpose of hemostasis. Generally, microwave with output wavelength of 12cm, frequency of 2450MHz and power of 100w is used. Under the direct vision of endoscope, aim the microwave probe at the bleeding focus and gently press it for microwave coagulation. When the power is adjusted to 40 ~ 50W (50 ~ 60mA) and the coagulation time is 10~20s ~ 20s, the pathological tissue becomes weak and the bleeding stops. After microwave coagulation to stop bleeding, tissue repair is mostly completed within 2 ~ 4 weeks. Endoscopic microwave coagulation hemostasis is simple in operation and low in equipment cost.
(4) High-frequency electrocoagulation: High-frequency current is used to generate thermal effect in local tissues, so as to coagulate protein and embolize blood vessels, thus achieving the purpose of hemostasis. Electrocoagulation has little damage to tissue and can only be used when the bleeding point is clear. Massive bleeding affects the hemostatic effect of electrocoagulation. After endoscopic examination found the bleeding focus, the high-frequency power supply was turned on, and the electrode plate was discharged on the patient's leg, and the power supply was confirmed to be normal. The current intensity of solidification is generally 2 or 3, and the time is 1 ~ 2s. Select a suitable probe, press the electrocoagulation head on the bleeding site under the direct vision of the endoscope, and turn on the electrocoagulation current, which can be repeated several times until the tissue turns white and the bleeding stops. Observe for a few minutes after stopping bleeding. If there is no bleeding again, you can exit the electrocoagulation head and endoscope. After electrocoagulation, the electrode is attached to the charred tissue. If you pull the probe hard, it is easy to bring back the eschar tissue and cause rebleeding. Therefore, when removing the electrocoagulation head, the power supply must be cut off first to prevent secondary bleeding. High-frequency electrocoagulation is simple to stop bleeding, and it is suitable for various bleeding situations such as jet bleeding, active oozing, hemispheric vascular exposure, scattered bleeding points and so on.
(5) Laser therapy: Based on the principle that the irradiated tissue surface can be converted into heat energy after being absorbed, the irradiated local tissue will generate high temperature after absorbing light energy, so that protein will solidify and water will evaporate, thus achieving the purpose of photocoagulation and hemostasis. After endoscopic examination found the bleeding focus, it was sent to the timely fiber electrode from the biopsy hole, aimed at the bleeding focus with a distance of 0.5 ~ 1.0 cm, and repeated irradiation for 1 ~ 3 s each time until the mucosa of the bleeding focus turned white or dark brown, indicating that the bleeding stopped. Endoscopic laser irradiation has a reliable hemostatic effect and can be used in any gastrointestinal tract that can be touched by endoscope. But the laser photocoagulation instrument is expensive and inconvenient to move. In addition, laser hemostasis will cause some serious complications, such as gastrointestinal perforation, bleeding and flatulence. The main causes of gastrointestinal perforation are too high power or too long irradiation time/kloc-0. The incidence of perforation was 65438 0%.
(6) Injection combined with hyperthermia: Injection combined with one of the above hyperthermia can improve the hemostasis effect, temporarily stop bleeding after injection of drugs, improve the visibility of bleeding points, and make hyperthermia more accurate and effective in hemostasis.
(7) Hemostatic clip therapy: The principle of hemostatic clip is similar to that of biopsy forceps, but the clamp flap is clip-shaped. After clamping the small blood vessel, the clamp can be detached from the operating part and still clamp the blood vessel. After a few days, it will form a blood clot when it falls off, thus achieving the purpose of stopping bleeding. Hemostatic forceps is mainly used for bleeding caused by vascular exposure. 1 failure, which can be repeated several times until the hemostasis is satisfactory.
(8) Ligation therapy: Compared with other endoscopic treatment methods, this method is relatively easy to operate, especially suitable for the lesions at the junction of esophagus and stomach and the posterior wall of upper stomach. The focus with the diameter of 1cm can be ligated, and the focus can be sucked into the transparent cap at the top of the endoscope, so that the visual field is clear and the hemostatic effect is positive. But it takes time to install the ligator. For those who are ineffective in injection therapy or have recurrent bleeding, you can choose. Ulcer was formed on the mucosal surface of the ligation site after operation, but no recurrent bleeding was formed. Selective celiac arteriography and embolization for Dieulafoy's disease are rarely reported. It should be used as a particularly useful treatment for patients who fail in endoscopic treatment but cannot tolerate surgery. Literature reported that 4 cases underwent selective celiac arteriography and left gastric artery embolization at the same time, 3 cases stopped bleeding after treatment, 1 case underwent surgery after treatment failure. There are three conditions for choosing embolization:
(1) Intubation entered the left gastric artery superselective.
(2) Angiography confirmed that there were no collateral vessels in the focus and bleeding point.
(3) The vital signs are stable and there is enough time for embolization. In the past, surgery was considered as the first choice to treat Dieulafoy's disease. With the development of endoscopic treatment, surgical treatment has tended to be endoscopic treatment first, and those who fail to respond to endoscopic treatment should be operated decisively. Surgical methods include electrocoagulation at bleeding point, suture hemostasis, proximal subtotal gastrectomy and local wedge resection. Electrocoagulation suture is simple, but postoperative bleeding is easy to recur. Recently, extensive wedge gastrectomy has been advocated, because the equal-diameter artery has a long journey in the gastric mucosa, and the cause can be removed after resection to avoid recurrence of bleeding. The final diagnosis can be obtained through pathological examination of the resected specimen. During the operation, the gastric mucosa should be carefully examined to determine the location of Dieulafoy focus. When the bleeding point or focus is not clear, it is forbidden to blindly perform Billroth-Ⅱ subtotal gastrectomy. If you do this operation, you will definitely bleed after the operation and the prognosis will be poor.