Recurrent intestinal bleeding successfully treated by double-balloon endoscopy in a hemodialysis patient

Abstract

The patient was a 70-year-old male who started to receive hemodialysis due to diabetic nephropathy in 1992. He developed hematochezia from 1995. Though he had undergone both upper and lower gastroenteral endoscopy repeatedly, the bleeding point was not determined. Scintigram performed to detect gastrointestinal hemorrhage demonstrated an accumulation of activity on the right side of the common iliac artery. Because his blood type was AB and D negative, he was difficult to match for blood transfusion. He was referred to our hospital in June 2006 for more extensive examination and treatment. He underwent double-balloon endoscopy which showed red spots at the middle portion of the jejunum. We treated this lesion using Argon plasma coagulation (APC) and clipping. Thereafter, the same type of lesions appeared four times in different portions of the intestine. However, we successfully treated these by the same method. The prevalence of gastrointestinal bleeding is reportedly higher among ESRD patients than the general population. However, we often could not determine the exact bleeding point and often found it difficult to achieve hemostasis especially for small intestinal lesions. We consider the double-balloon endoscopy technique useful for diagnosis of either jejunal or ileal lesions and that the technique in itself offers a strategy for treating such patients.