title: Endoscopic treatment of duodenal bleeding caused by direct hepatocellular carcinoma invasion with an ethanol injection.
abstract: We report a case of a man who developed duodenal bleeding caused by direct hepatocellular carcinoma (HCC) invasion, which was successfully treated with endoscopic ethanol injection. A 57-year-old man with known HCC was admitted for melena and exertional dyspnea. He had been diagnosed with inoperable HCC a year ago. Urgent esophagogastroduodenoscopy (EGD) showed two widely eroded mucosal lesions with irregularly shaped luminal protruding hard mass on the duodenal bulb. Argon plasma coagulation and Epinephrine injection failed to control bleeding. We injected ethanol via endoscopy to control bleeding two times with 14 cc and 15 cc separately without complication. Follow-up EGD catched a large ulcer with necrotic and sclerotic base but no bleeding evidence was present. He was discharged and he did relatively well during the following periods. In conclusion, Endoscopic ethanol injection can be used as a significantly effective and safe therapeutic tool in gastrointestinal tract bleeding caused by HCC invasion.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Jin Nam
authors.initials: JN
authors.lastname: Kim
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Seung Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Jung
authors.forename: Ja Seol
authors.initials: JS
authors.lastname: Koo
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lee
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu