Fig. 10.1
(a) Massive bleeding with ulceration is observed at the ileocolonic anastomosis of patients with Crohn’s disease, and (b) blood vessel is exposed (white arrow). (c) Endoscopic hemostasis was successfully conducted
Blood in stool and melena in patients with UC are usually treated with medical treatments, such as 5-aminosalicylates, corticosteroids, or other immunosuppressive agents. Endoscopic hemostasis is very uncommon in UC patients. However, Dieulafoy’s ulceration (exposed vessel on ulceration) may cause severe bleeding even when clinical and endoscopic remission is obtained (at 11 months prior to massive bleeding) as Fig. 10.2 indicates. Endoscopic hemostasis is also useful for this case.
Fig. 10.2
(a) Dieulafoy’s ulceration is detected in the rectum of patients with ulcerative colitis. Mild inflammation with friability and no-vessel pattern is observed around “bleeding spot.” (b) Endoscopic hemostasis was successfully conducted
10.2 Endoscopic Balloon Dilatation
Strictures are observed approximately in one-third of patients with Crohn’s disease, and it causes severe abdominal symptoms. More than half of patients with CD need surgery within the first 10 years after onset of disease, and strictures and obstructions were one of the common indications for surgery. To improve clinical outcome, it is critical to prevent progression of strictures as early as possible. Strictures may be categorized as fibrotic type and inflammatory types. For inflammatory strictures, medical treatments may be useful to improve the lesions, whereas these are not effective for fibrotic strictures without inflammation in most cases. Endoscopic balloon dilatation (EBD) (Figs. 10.3a–d and 10.4a–d) may relieve abdominal symptoms and prevent surgery in some cases of CD. Fibrotic, shorter length of strictures and no/mild inflammation around stenosis are indicative for EBD (Table 10.1). At the procedures of EBD, the number of strictures, length and diameter of strictures, and presence of intra-intestinal fistula should be confirmed by small bowel follow-through (Fig. 10.3e) or other diagnostic devices.
Fig. 10.3
(a) Severe stricture is detected in the distal ileum of patients with Crohn’s disease. No ulceration is found. (b) Dilator is inserted into the strictures, and (c) endoscopic balloon dilation is performed. (d) Stricture was significantly improved, and colonoscopy could be passed beyond the stricture. (e) Before procedure of endoscopic balloon dilation, stricture without fistula was confirmed using radiological examination
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