REFLEUX ESOPHAGITIS WITH SPURTING BLEEDING TREATED BY ENDOSCOPIC HEMOSTASIS

Abstract

A 44-year-old man was hospitalized due to diabetic ketoacidosis. Intravenous administra-tion of saline along with insulin led to the amelioration of his general condition with a negativity of urinary ketone as well as improved blood sugar. On the 12th hospitalization day, he had a massive hematemesis. Emergent endoscopy revealed reflux esophagitis with spurting bleeding classified as grade D of Los Angels classification. Endoscopic hemostasis was successfully done using tip forceps with soft coagulation mode of a high frequency generation ICC200, leading to the successful prevention of sequent rebleeding with acid-suppressive therapy using proton pump inhibitors (PPIs). On the 37th hospitalization day, Endoscopic ultrasonography revealed a blood vessel in the submucosal area of post-treated lesion, which was considered a bleeding origin. This is the rare case of reflux esophagitis with spurting bleeding that was successfully treated by endoscopy and of which origin was identified using endoscopic ultrasonography.