| 特集名 | 消化管出血に対する診療―JGESガイドラインをふまえて | |
|---|---|---|
| 題名 | 大腸憩室出血に対するアプローチ | |
| 発刊年月 | 2017年 03月 | |
| 著者 | 石井 直樹 | 聖路加国際病院消化器センター |
| 著者 | 池谷 敬 | 聖路加国際病院消化器センター |
| 著者 | 岡田 修一 | 聖路加国際病院消化器センター |
| 著者 | 藤田 善幸 | 聖路加国際病院消化器センター |
| 【 要旨 】 | 高齢化，高血圧や動脈硬化症といった既往症の増加，抗血栓薬や非ステロイド性抗炎症薬（NSAIDs）の頻用により，大腸憩室出血症例は増加傾向にある．診断のモダリティとして大腸内視鏡検査が第一選択と考えられるが，上部消化管出血が否定できない場合には上部消化管内視鏡検査の先行が望ましい．早期に大腸内視鏡検査を行うことによる再出血率の低下や入院期間の短縮は認められていないが，出血源の同定率や内視鏡治療への移行において有意な改善が得られる可能性がある．内視鏡治療として，高周波凝固法，エピネフリン局注法，クリップ法，EBLがある．内視鏡的止血術後は遅発性再出血の予防も重要である． | |
| Theme | Diagnoses & Treatments for Gastrointestinal Bleeding on the Basis of JGES Guidelines | |
|---|---|---|
| Title | Approach to the Management of Colonic Diverticular Bleeding | |
| Author | Naoki Ishii | Center of Gastroenterology, St. Luke's International Hospital |
| Author | Takashi Ikeya | Center of Gastroenterology, St. Luke's International Hospital |
| Author | Shuichi Okada | Center of Gastroenterology, St. Luke's International Hospital |
| Author | Yoshiyuki Fujita | Center of Gastroenterology, St. Luke's International Hospital |
| [ Summary ] | Colonic diverticular hemorrhage is the most common cause of lower gastrointestinal bleeding (LGIB) and its incidence is rising due to increasing comorbidities, such as hypertension and arteriosclerosis, and the regular use of anti‒platelet agents and non‒steroidal anti‒inflammatory drugs (NSAIDs). Colonoscopy after purging should be the initial diagnostic procedure for patients with acute LGIB. However, hematochezia associated with hemodynamic instability may be indicative of upper gastrointestinal bleeding and esophagogastroduodenoscopy should be performed before colonoscopy in these cases. Studies of the optimal timing of colonoscopy in the setting of acute LGIB are limited. Early colonoscopy does not seem to be associated with rebleeding or length of stay. However, it can be associated with a higher rate of source localization and endoscopic treatments. Colonic diverticular hemorrhage appears to resolve spontaneously in about 75 % of cases but interventions are required in cases with severe or continuous bleeding. Endoscopic treatments for hemostasis include epinephrine injection, contact thermal therapy, and endoscopic clipping. Recently, endoscopic band ligation (EBL) has also been performed to achieve hemostasis. Even after successful endoscopic hemostasis is achieved, rebleeding sometimes occurs. Therefore, it is important to take steps to prevent rebleeding, such as encouraging the patient to refrain from taking NSAIDs. |
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