CA LÂM SÀNG: ĐIỀU TRỊ XUẤT HUYẾT TIÊU HÓA NẶNG DO LOÉT TO HÀNH TÁ TRÀNG QUA NỘI SOI VỚI CLIP OTSC (THE OVER-THE-SCOPE CLIP) SAU THẤT BẠI VỚI CÁC BIỆN PHÁP CẦM MÁU THÔNG THƯỜNG

Abstract

Current endoscopic hemostatic techniques are the primary methods used to control bleeding caused by peptic ulcers. Recently, the Over-The-Scope Clip (OTSC) has been developed and increasingly applied in managing severe gastrointestinal hemorrhage secondary to peptic ulcer disease. We report a case of an 80-year-old female patient with a medical history of multiple myeloma undergoing chemotherapy, who was admitted to a hospital in Singapore due to upper gastrointestinal bleeding caused by a duodenal bulb ulcer (Forrest IIa). The patient underwent two sessions of endoscopic hemoclip application, one angiographic embolization, and partial gastroduodenal resection, all of which failed to control the bleeding. The patient was subsequently transferred to another hospital in Vietnam, where another attempt at endoscopic hemoclip application was made, also without success. The patient was then referred to our hospital in a critical condition, requiring mechanical ventilation and sedation, presenting with hypovolemic shock and acute kidney injury necessitating continuous renal replacement therapy. After intensive resuscitation, endoscopic evaluation was performed, revealing a fibrotic ulcer measuring 1.5–2 cm with active oozing bleeding (Forrest IB) located opposite the papilla in the duodenum. Successful endoscopic hemostasis was achieved through adrenaline injection followed by application of an OTSC clip. The patient remained stable and was discharged after completing treatment. This case highlights that, alongside appropriate resuscitative measures, the use of OTSC in endoscopic management plays a critical role in achieving hemostasis in large, fibrotic ulcers.