Constant diameter arterial hemorrhage refers to the presence of abnormally developed wall-penetrating arterial vessels in the gastrointestinal tract, whose diameters are thicker than those of submucosal vessels, and severe hemorrhage often occurs when the mucous membranes in which they are located are damaged, and almost all of the cases reported so far and the ones that we have found have occurred in the upper gastrointestinal tract, and they are relatively more common in the stomach. Such cases are not clinically frequent, but by no means rare, now on my personal knowledge of this disease and clinical cases encountered, to talk about their own insights. 1, diagnosis 1.1 clinical diagnosis The most important feature of this disease is the suddenness and severity of bleeding. Such patients often have sudden attacks of vomiting blood and black stools, and the amount of bleeding is particularly large, often in a relatively short period of time, circulatory disorders (shock), and in the active transfusion of fluids and blood transfusion and other treatments, the bleeding will immediately stop, and at this time, the examination is often not a positive finding, and even under the gastroscope it is difficult to find the lesion. Therefore, we must consider the possibility of this disease when encountering patients with recurrent and sudden hemorrhage, especially when there is no positive finding under gastroscopy. 1.2 Endoscopic diagnosis Theoretically speaking, gastroscopy is very intuitive for the diagnosis of this disease, however, due to the timing of the implementation of gastroscopy and the patient’s condition at the time and other factors, resulting in a positive rate is not too high, and it has been proven in practice that repeated gastroscopy can increase the rate of positivity, and gastroscopy can be carried out within two hours after the emergence of vomiting blood to increase the rate of positivity, and also in the case of gastroscopy if there is an accumulation of blood in the stomach, you should Finding fresh bleeding, or changing the patient’s position, can often increase the positive rate as well. It is important to note that some patients do not find an obvious bleeding site during gastroscopy, but multiple sites are found, and at this point it is often forgotten where the actual bleeding site is because this site was found. It is reasonable that every mucosal fold should be carefully examined during gastroscopy when the stomach is distended, but often the treatment can only be finished as soon as possible because the patient’s condition does not allow it, and other constraints. 1.3 Other diagnostic methods High-sorting angiography in radiologic imaging can detect lesions in active bleeding, and can be used as one of the clinical alternatives due to the limitations of interventional radiology and the high equipment conditions required. 2.1 Internal medicine treatment For patients with this kind of disease, the focus of internal medicine treatment is to maintain the stability of blood circulation, active examination, and strive to clarify the location of the lesion and the nature of the lesion as soon as possible, once the diagnosis is clear, it should be taken as soon as possible to take active endoscopic treatment, radiological intervention therapy and surgical treatment. It is worth noting that when adopting these more effective treatments, maintaining circulatory stability is still the focus that must be adhered to, and can be said to be the basic treatment. 2.2 Endoscopic treatment With the rapid change of science and technology, gastroscopic treatment measures have more means to provide clinical choices, among which electrocoagulation, ligation, vascular clamps and other measures are widely used, and the indications for such methods of treatment are those who are difficult to tolerate surgery and anesthesia, or those who are unable or unwilling to undergo surgical operation for some reasons. Due to the limitations of endoscopic surgery, we must fully inform and obtain the understanding and informed consent of the affected party before the surgery is performed, which is demonstrated by the signing of a written surgical consent form. According to the current laws and regulations, special cases can also be implemented with the consent of the hospital leadership. 2.2.1 Electrocoagulation refers to the use of radiofrequency or high-frequency electric knife to electrocoagulate the tissue surrounding the lesion, so as to make the tissue swollen and denatured by electrocoagulation compress the lesion blood vessels and prompt intravascular coagulation, followed by the formation of thrombus, so as to achieve the purpose of stopping bleeding. This technique is more demanding for gastroscopists, who must strictly control the degree and location of electrocoagulation and strive to get it just right, that is to say, the operator is required to have a wealth of clinical diagnosis and treatment and endoscopic diagnosis and treatment experience. Otherwise, the coagulation will lead to more serious hemorrhage. This method is suitable for the lesion of the blood vessels is quite thin, the main manifestation of blood seepage, there are also blood spurt after electrocoagulation treatment and healing cases, our hospital has had a number of successful examples. 2.2.2 Sleeving is another method that can be chosen under gastroscopy, which is suitable for cases with relatively thick lesion vessels, and can be performed when active bleeding stops or is less frequent, so as to ensure a better field of vision. The specific method is to align the lesion with the endoscope fitted with a lancing device, then negative pressure suction makes the lesion completely enter the transparent cap, and then release the rubber band. Once this method is successful, the effect is significantly better than electrocoagulation, but the cost is quite expensive. 2.2.3 Vascular clamp is another method that can be chosen in gastroscopy, where a metal clamp is released on the lesion through the endoscopic appendage to achieve hemostasis by the principle of physical compression. This method is suitable when there is active bleeding and the amount of bleeding is relatively large. Because this method requires special endoscopic accessory equipment (metal clip release device), metal clips are more expensive, so it is difficult to carry out in primary hospitals. 3.Surgical treatment Surgical treatment is one of the most thorough treatment methods. Surgery is one of the most thorough treatment methods. The specific method is to surgically remove the part where the lesion is located, completely eradicating the lesion to achieve the purpose of eradicating the disease. The premise of surgery is to find the exact location of the lesion so as not to remove unnecessary tissue, so this method is only used as a last resort. Due to the conditions required for surgery and the relatively high risk of non-surgical methods, often subject to a variety of reasons for constraints, so, although surgery is the last resort but not the best choice for eradication. 4, other treatments Radiological intervention is a more commonly used method in addition to the above methods. The principle is to insert the catheter into the upper trunk of the arterial vessels of the target lesion, and then find the lesion vessels by angiography with the performance of contrast leakage (smoke sign), and then embolize the lesion vessels so that the lesion vessels can be occluded to achieve the purpose of hemostasis. The advantage of this method is that it is less traumatic and does not require general anesthesia, but because the vessel reached by the catheter is often the upper trunk of the focal vessel, there is a possibility of embolizing other parts at the same time, the requirements for equipment and operators are also higher, and at the same time, due to the surgery under the radiation, there is a certain degree of risk for both patients and medical personnel, and the cost is much more expensive than that of endoscopic treatment. 5, clinical diagnosis and treatment ideas When we face a patient who vomits blood and has a large amount of black stool, the first thing we should do is to maintain the stability of the circulation, on this basis, actively carry out the endoscopic diagnosis and treatment of pre-preparation, in the appropriate time for the examination of the gastroscope, the inspection if the lesion is found, it should be endoscopically treated immediately, and then go back to the ward to observe whether the bleeding stops and reoccurrence, if reoccurrence is directly to the surgical operation; if the gastroscope fails to find the lesion, and there is a reoccurrence of gastroscopy, the gastroscope can not detect the lesion. If gastroscopy fails to find the lesion and there is a recurrence of vomiting blood and black stool, gastroscopy should be performed again within 2-4 hours after the occurrence of vomiting blood to find the lesion and treat it aggressively. The importance of comprehensive treatment should be emphasized for such patients. As to how to choose the specific method, it should be determined on a case-by-case basis. For patients with recurrent episodes of vomiting blood and black stools within a short period of time, especially if the initial gastroscopy does not show any obvious abnormality, i.e., the gastroscopic findings are not quite consistent with the clinical manifestations, the possibility of the disease should be thought of, and the gastroscopy should be rechecked as soon as possible. This should not be difficult to implement in hospitals with complete gastroenterology departments, but may be difficult to do in hospitals with separate gastroenterology wards and gastrointestinal endoscopy laboratories. The main reason for this is often due to the thinking of the clinical ward physicians and the consistency of their observation of the disease. The current view of treatment is to carry out endoscopic diagnosis and treatment under the premise of ensuring circulatory stability, and when endoscopic treatment is ineffective, to choose radiological intervention or direct surgical treatment.