We report here on a case of recurrent bleeding secondary to duodenal ulcer, despite
previous endoscopic treatment with epinephrine and argon, which was controlled with
endoscopic injection of collagen/povidone. This is a biological agent derived from
gamma-irradiation of a mixture of type I pepsinated porcine collagen and povidone
that has been reported to improve recovery during the healing process [1]
[2].
A 63-year-old man with history of chronic use of nonsteroidal anti-inflammatory drugs
presented with hematemesis and melena. Endoscopic examination revealed a large ulcer
in the second portion of the duodenum, with two visible vessels, which were sclerosed
with 1 : 10 000 epinephrine and argon. Nine days after this procedure, the patient
had a new bleeding event, with the same endoscopic features (Figure [1]), and received the same treatment. Hemoclips were not used, as almost the entire
surface of the extensive lesion was thickened and bleeding, so that clips could not
be attached. After 2 days, in view of continuing bleeding, it was decided to administer
4 ml of collagen/povidone in 10 ml of distilled water through the endoscope, injecting
3 ml into the lesion and 7 ml on the surface. Significant improvement in the lesion
was observed 24 h after the collagen/povidone injection (Figure [2]). Notable healing was evident 72 h later, and there was no subsequent bleeding.
Figure 1 a Recurrent bleeding, b sclerosed with epinephrine and argon.
Figure 2 a, b The endoscopic appearance 24 h after treatment with collagen-povidone.
In this particular case, collagen-povidone proved to be a good treatment option, and
controlled studies of it as a new sclerosant agent may be worth considering.
Endoscopy_UCTN_Code_TTT_1AO_2AD
