Introduction

Peptic ulcers account for 50% of upper gastrointestinal bleeding incidents. Bleedings from large vessels, such as the gastroduodenal artery, are associated with increased mortality. Ulcers located on the posterior wall of the duodenum show the highest risk for erosion of the gastroduodenal artery. Endoscopic management is challenging and rebleeding rates are high due to internal and external confounding factors such as anatomical variability and gastric insufflation. We aimed to correlate macroscopic and endoscopic anatomy for assessment of implications for clinical management.

Material and methods

The gastroduodenal artery was dissected in 10 anatomical specimens. The points of contact of the artery with the posterior wall of the duodenum were marked with needles. The endoluminal position of the needles was recorded by standardized gastroscopy and a 3-dimensional virtual reconstruction was carried out for visualization of the artery's course.

Results

The artery's proximal and distal points of contact with the duodenum were 27.2 mm (range 15–30 mm; SD 6.7 mm) and 15 mm (range 10–20 mm; SD 3.5 mm), respectively, from the pylorus. The gastroduodenal artery branches from the common hepatic artery within the omentum minus running adjacent to the duodenal wall to the head of the pancreas. From endoscopic perspective, the gastroduodenal artery's course was directed towards the tip of the gastroscope.

Conclusion

Due to the peculiar extraluminal course of the gastroduodenal artery the arterial blood flow projects into the direction of the gastroscope during endoscopic intervention. Measures for bleeding control might have to be applied aboral from the bleeding site.

中文翻译：

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胃十二指肠动脉的内窥镜投影：对出血处理的解剖学意义。

介绍

消化性溃疡占上消化道出血事件的50％。大血管（如十二指肠动脉）的出血与死亡率增加有关。位于十二指肠后壁的溃疡表现出最高的胃十二指肠动脉侵蚀风险。内窥镜治疗极具挑战性，并且由于内部和外部的混杂因素（例如解剖学变异性和胃吹气），再出血率很高。我们旨在关联宏观和内窥镜解剖结构，以评估对临床管理的影响。

材料与方法

将胃十二指肠动脉解剖为10个解剖标本。用针标记动脉与十二指肠后壁的接触点。通过标准胃镜检查记录针的腔内位置，并进行3维虚拟重建以可视化动脉的走向。

结果

动脉与十二指肠的近端和远端接触点距幽门分别为27.2 mm（范围15–30 mm； SD 6.7 mm）和15 mm（范围10–20 mm； SD 3.5 mm）。胃十二指肠动脉从大网膜内的肝总动脉分支，靠近十二指肠壁延伸到胰头。从内窥镜的角度来看，十二指肠动脉的路线指向胃镜的尖端。

结论

由于胃十二指肠动脉的腔外过程，在内窥镜介入过程中，动脉血流向胃镜的方向突出。止血措施可能必须从出血部位向内进行。