Gastroenterologie
a hepatologie

Successful treatment of a bleeding duodenal ulcer using an over-the-scope clip in a five-year-old patient

David Klepárník¹, Lumír Kunovský^2,3,4, Přemysl Falt⁵, Břetislav Sobota¹, Marie Rohanová¹, Radka Drápalová¹, Lenka Bakaj Zbrožková⁶, Eva Karásková¹

+ Affiliation
¹ Dětská klinika LF UP a FN Olomouc
² Chirurgická klinika LF MU a FN Brno
³ II. interní klinika – gastroenterologická a geriatrická LF UP a FN Olomouc
⁴ Gastroenterologické oddělení a digestivní endoskopie, LF MU a MOÚ, Brno
⁵ II. interní klinika – gastroenterologická a geriatrická LF UP a FN Olomouc
⁶ Radiologická klinika LF UP a FN Olomouc

Summary

Upper gastrointestinal bleeding (UGIB) is a serious or even life-threatening event. In childhood, gastroduodenal ulcer dis­ease is the second most common cause of UGIB after erosive gastritis. Risk factors for ulceration include Helicobacter pylori (H. pylori) infection and use of non-steroidal anti-inflammatory drugs. Patients in shock and on artificial pulmonary ventilation are also at increased risk. In addition to H. pylori, infections with Cytomegalovirus, Herpes simplex virus, or tuberculosis may contribute to the development of peptic ulceration. Ulceration may be a manifestation of Crohn‘s dis­ease, Zollinger-Ellison syndrome, and other less common dis­eases. A case report of a 5-year-old boy with two attacks of melena, collapse and vomiting of blood is presented. Endoscopically, an ulceration of the duodenal bulb was found with a stump of a blood vessel at the base (Forrest IIa). Primary treatment with standard endoclips inserted through the working channel of the endoscope (TTS clip –  through-the-scope clip) failed, as did treatment with the thermal method using argon-plasma coagulation. Successful treatment of the ulcer was achieved only with the use of an over-the-scope clip (OTSC). In addition to commentary on the use of OTSC in children, the etiology of the patient‘s problems is discussed, from H. pylori infection, to the influence of ongoing intercurrent infections with the administration of nonsteroidal anti-inflammatory drugs as a risk factor, and in terms of the development of UGIB, to rare and infrequent causes.

Keywords

peptic ulceration, melena, hematemesis, children, endoscopic treatment

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Literature

1. Sur LM, Armat I, Sur G et al. Practical aspects of upper gastrointestinal bleeding in children. J Clin Med 2023; 12(8): 2921. doi: 10.3390/ jcm 12082921.
2. Ecevıt ÇÖ, Özgenç F, Yüksekkaya HA et al. Peptic ulcer dis­ease in children: an uncommon disorder with subtle symptomatology. Turk J Gastroenterol 2012; 23(6): 666– 669. doi: 10.4318/ tjg.2012.0562.
3. Brown K, Lundborg P, Levinson J et al. Incidence of peptic ulcer bleeding in the US pediatric population. J Pediatr Gastroenterol Nutr 2012; 54(6): 733– 736. doi: 10.1097/ MPG.0b0 13e31824fb7f9.
4. Kliegman RM, St Geme JW, Blum NJ et al. Nelson Textbook of pediatrics. Philadelphia: Elsevier 2025: 2305– 2308.
5. Zádorová Z. Nesteroidní antiflogistika v gastroenterologii. Med Praxi 2010; 7(12): 466– 468.
6. Carley NH. Streptococcus salivarius bacteremia and meningitis fol­lowing upper gastrointestinal endoscopy and cauterization for gastric bleeding. Clin Infect Dis 1992; 14(4): 947– 948. doi: 10.1093/ clinids/ 14.4.947.
7. Guo F, Li L, Li L. Streptococcus anginosus: a new pathogen of superficial gastritis, atrophic gastritis and gastric cancer. Biomol Biomed 2024; 24(5): 1040– 1043. doi: 10.17305/ bb.2024. 10705.
8. Cappell MS, Friedel DM. Gastrointestinal bleeding in COVID-19-infected patients. Gastroenterol Clin North Am 2023; 52(1): 77– 102. doi: 10.1016/ j. gtc.2022.10.004.
9. You GR, Park SY, You HS et el. Clinical characteristics of cytomegalovirus dis­ease of the upper gastrointestinal tract: a 10-year multicenter retrospective study. Korean J Helicobacter Up Gastrointest Res 2023; 23(4): 294– 301. doi: 10.7704/ kjhugr.2023.0054.
10. Armstrong KL, Fraser DK, Faoagali JL. Gastrointestinal bleeding with influenza virus. Med J Aust 1991; 154(3): 180– 182. doi: 10.5694/ j. 1326-5377.1991.tb121025.x.
11. Ishimoto K, Yoshimaru K, Uchida Y et al. Massive bleeding from a duodenal ulcer in a child with influenza infection: a case report of endoscopic findings. DEN Open 2022; 3(1): e155. doi: 10.1002/ deo2.155.
12. Roca EC, Vivas RF, Belda MT. A gastrointestinal complication of mycoplasma infection to take into account. An Pediatr 2019; 91(3): 199– 200. doi: 10.1016/ j. anpedi.2018. 07.002.
13. Wright R, Abrajano C, Koppolu R et al. Initial results of endoscopic gastrocutaneous fistula closure in children using an over-the-scope clip. J Laparoendosc Adv Surg Tech A 2015; 25(1): 69– 72. doi: 10.1089/ lap. 2014.0379.
14. Kondo T, Mori H, Kobara H et al. Application of over-the-scope clip for massive duodenal ulcer bleeding in a 4-year-old boy weighing 7.8 kg. Endoscopy 2018; 50(2): E46– E47. doi: 10.1055/ s-0043-120520.
15. Tran P, Carroll J, Barth BA et al. Over the scope clips for treatment of acute nonvariceal gastrointestinal bleeding in children are safe and effective. J Pediatr Gastroenterol Nutr 2018; 67(4): 458– 463. doi: 10.1097/ MPG.0000000000 002067.
16. Sharma S, Barakat M, Urs A et al. Applicability, efficacy, and safety of over-the-scope clips in children. Gastrointest Endosc 2022; 95(3): 489– 499. doi: 10.1016/ j. gie.2021.10.011.
17. Soriani P, Biancheri P, Bonura GF et al. Over-the-scope clip as first-line treatment of peptic ulcer bleeding: a multicenter randomized controlled trial (TOP Study). Endoscopy 2024; 56(9): 665– 673. doi: 10.1055/ a-2303-4824.