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Jo SY, Noh JH, Cha B, Ahn JY, Oh SP, Seo JY, Na HK, Lee JH, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding. J Gastroenterol Hepatol 2023. [PMID: 36740948 DOI: 10.1111/jgh.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Although Dieulafoy's lesion (DL) is an important cause of nonvariceal upper gastrointestinal (GI) bleeding, few studies have investigated the clinico-epidemiological outcomes due to its rarity. Here, we investigated clinical features of upper GI bleeding caused by peptic ulcer (PU) or DL and compared endoscopic treatment outcomes. METHODS Patients with upper GI bleeding resulting from PU or DL who visited emergency room between January 2013 and December 2017 were eligible. Clinical features and treatment outcomes were retrospectively investigated. RESULTS Overall, 728 patients with upper GI bleeding due to PU (n = 669) and DL (n = 59) were enrolled. The median age was 64 years (interquartile range [IQR], 56-75 years), and 74.3% were male. Endoscopic intervention was performed in 53.7% (n = 359) and 98.3% (n = 58) of the PU and DL groups, respectively (P < 0.0001). Patients were matched by sex, age, body mass index, comorbidity, and past medical history, and 190 PU and 52 DL were finally selected. The rebleeding rates within 7 (7.37% vs 17.31%, P = 0.037) and 30 (7.37% vs 26.92%, P < 0.001) days after initial endoscopy were significantly lower in the PU than in the DL group after propensity score matching. During the median follow-up period of 52 months (IQR, 34-70 months), there was no difference in overall survival rate (67.9% vs 82.7%, P = 0.518). CONCLUSIONS Although DL is a rare cause of upper GI bleeding, it requires endoscopic hemostasis more frequently and has a higher rate of rebleeding than PU even after therapeutic endoscopy. Endoscopists should pay attention and perform active endoscopic hemostasis for DL bleeding.
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Affiliation(s)
- Sang Yong Jo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boram Cha
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Pyo Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Young Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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2
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Nulsen B, Jensen DM, Kovacs TOG, Ghassemi KA, Kaneshiro M, Dulai GS, Jutabha R, Gornbein JA. Outcomes in Severe Upper GI Hemorrhage from Dieulafoy's Lesion with Monitoring of Arterial Blood Flow. Dig Dis Sci 2021; 66:3495-3504. [PMID: 33128681 DOI: 10.1007/s10620-020-06679-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dieulafoy's lesion (DL) is a rare but increasingly recognized cause of severe upper GI hemorrhage (SUGIH). There is little consensus regarding the endoscopic approach to management of bleeding from DL. AIMS Our purposes were to compare 30-day outcomes of patients with SUGIH from DL with Doppler endoscopic probe (DEP) monitoring of blood flow and guided treatment versus standard visually guided hemostasis (VG). METHODS Eighty-two consecutive DL patients with SUGIH were identified in a large CURE Hemostasis database from previous prospective cohort studies and two recent RCTs at two university-based medical centers. 30-day outcomes including rebleeding, surgery, angiography, death, and severe medical complications were compared between the two treatment groups. RESULTS 40.2% of DL bleeds occurred in inpatients. 43.9% of patients had cardiovascular disease, and 48.7% were taking medications associated with bleeding. For the entire cohort, 41.3% (26/63) of patients treated with VG had a composite 30-day outcome as compared to 10.5% (2/19) of patients treated with DEP (p = 0.017). Rebleeding occurred within 30 days in 33.3% and 10.5% of those treated with VG and DEP, respectively (p = 0.051). After propensity score matching, the adjusted 30-day composite outcome occurred in 39.0% in the VG group compared to 2.6% in the DEP group (p < 0.001). Adjusted 30-day rebleeding occurred in 25.3% in the VG group versus 2.6% in the DEP group (p < 0.001). DISCUSSION DL patients with SUGIH were frequently inpatients and had severe cardiovascular comorbidities and recurrent bleeding. Lesion arterial blood flow monitoring and obliteration are an effective way to treat bleeding from DL which reduces negative 30-day clinical outcomes.
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Affiliation(s)
- B Nulsen
- CURE Hemostasis Research Unit, Los Angeles, CA, USA. .,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA. .,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA.
| | - D M Jensen
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA.,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA
| | - T O G Kovacs
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA
| | - K A Ghassemi
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA
| | - M Kaneshiro
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA.,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA
| | - G S Dulai
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA
| | - R Jutabha
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10945 Le Conte Avenue, Suite 2114, Los Angeles, CA, 90095, USA.,West Los Angeles Veterans Administration Medical Center, Los Angeles, CA, USA
| | - J A Gornbein
- CURE Hemostasis Research Unit, Los Angeles, CA, USA.,Department of Medicine - GIM - DOMSTATS, UCLA, Los Angeles, CA, USA
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3
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Risk Factors for Rebleeding after Emergency Endoscopic Treatment of Dieulafoy Lesion. Can J Gastroenterol Hepatol 2020; 2020:2385214. [PMID: 32908851 PMCID: PMC7468603 DOI: 10.1155/2020/2385214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 12/23/2022] Open
Abstract
Background and Objective: Dieulafoy lesion is a rare, but life-threatening, cause of gastrointestinal hemorrhage, and endoscopic therapy is the preferred first-line treatment. The present study aims to analyze the risk factors for rebleeding after endoscopic hemostasis of gastroduodenal Dieulafoy lesion. Methods. A retrospective review of patients with Dieulafoy lesion who developed acute gastrointestinal bleeding and were treated primarily with endoscopic therapy from September 2014 to April 2019 was conducted. Results. A total of 133 patients with Dieulafoy lesion were included in the present study. The mean age of these patients was 56.05 ± 16.58 years, and 115 patients were male. Among these 133 patients, 26 patients developed rebleeding within 30 days of endoscopic therapy. The 30-day rebleeding rate for pure injection therapy (epinephrine, cyanoacrylate, or lauromacrogol injection alone), nonpure injection therapy (argon plasma coagulation, band ligation, and hemoclip application alone), and combination therapy (combination of any >2 methods) was 45.2%, 12.8%, and 11%, respectively. In the univariable analysis, endoscopic treatment, prothrombin time, gender, Rockall score, and leukocyte count were the risk factors for rebleeding. In the multivariable analysis, pure injection endoscopic treatment, white blood cells (>10 × 109/L), and prothrombin time >12 seconds were the independent risk factors for rebleeding. Conclusion. Patients who undergo pure injection endoscopic treatment and have a high leukocyte count (>10 × 109/L) or elevated prothrombin time (>12 seconds) have an increased risk of rebleeding within 30 days after endoscopic treatment for gastroduodenal Dieulafoy lesion. Combined endoscopic treatment is the most effective therapy to prevent rebleeding in gastroduodenal Dieulafoy lesion.
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Yu S, Wang XM, Chen X, Xu HY, Wang GJ, Ni N, Sun YX. Endoscopic full-thickness resection to treat active Dieulafoy's disease: A case report. World J Gastroenterol 2020; 26:4557-4563. [PMID: 32874064 PMCID: PMC7438190 DOI: 10.3748/wjg.v26.i30.4557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/06/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND At present, minimally invasive endoscopic treatment is mostly used for patients with actively bleeding Dieulafoy’s lesions, , as it has the advantages of minimal trauma, short operation time and good hemostatic effect, although bleeding can easily recur postoperatively. Recently, extensive gastric cuneiform resection has been advocated for use in these patients because the constant-diameter artery follows a long path to the gastric mucosa.
CASE SUMMARY A 47-year-old man was admitted to the hospital for repeated hematemesis and black stool, and he was diagnosed with Dieulafoy’s disease. We chose a method that not only simulates surgical gastric cuneiform resection but also reduces trauma. We performed enlarged local endoscopic full-thickness resection of the gastric wall and abdominal constant-diameter artery and sutured the gastric wall. Postoperative follow-up showed that the constant-diameter artery had been resected from the gastric wall, which was confirmed to have no blood flow signals by endoscopic ultrasonography.
CONCLUSION Endoscopic full-thickness resection of the gastric wall and abdominal constant-diameter artery with suturing of the gastric wall has demonstrated potential as a new treatment for Dieulafoy's disease.
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Affiliation(s)
- Shan Yu
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Xiao-Ming Wang
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Xin Chen
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Hong-Yan Xu
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Guang-Jie Wang
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Na Ni
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
| | - Yu-Xin Sun
- Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
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5
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Beatrice P, Lucia R, Antonio G, Domenico G, Mario S, Francesco C, Renato P. Rare case of upper gastrointestinal bleeding: Dieulafoy' s lesion of duodenum. A case report. Ann Med Surg (Lond) 2019; 45:19-21. [PMID: 31360454 PMCID: PMC6639656 DOI: 10.1016/j.amsu.2019.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 12/15/2022] Open
Abstract
Dieulafoy's lesion is an uncommon but important cause of recurrent upper gastrointestinal bleeding. Extragastric location of Dieulafoy's lesion is rare. We report a case of haemorrhagic shock due to delafoy ulcer of the duodenum. After the failure of endoscopic haemostatic treatment, and due to the hemodynamic instability, the patient was not a candidate for transarterial embolization, the emergency surgery was needed to stop the bleeding. Using minimally invasive technique, we were able to avoid radical surgery, in critical patient would have high mortality rate. Aggressive endoscopic examinations combined with the accurate treatment endoscopic, or after the failure of this, in cases of severe hemorrhagic shock, surgical approach should be adopted when Dieulafoy-like lesion is suspected as a possible cause of upper GI haemorrhage.
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Affiliation(s)
- Pessia Beatrice
- Department of General Surgery. Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Romano Lucia
- Department of General Surgery. Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giuliani Antonio
- Department of General Surgery. Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Schietroma Mario
- Department of General Surgery. Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlei Francesco
- Department of General Surgery. Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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6
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Liu HY, Sun L, Chen Y, Xv LY, Chen NN, Li YC. Progress in diagnosis and treatment of colorectal Dieulafoy's disease. Shijie Huaren Xiaohua Zazhi 2018; 26:1320-1328. [DOI: 10.11569/wcjd.v26.i21.1320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dieulafoy's lesion, also named calibre persistent submucosal artery, is one of the rare and fatal causes of gastrointestinal bleeding, which can occur throughout the digestive tract. About 4% of Dieulafoy's lesions are located in the colon and rectum, especially in the rectum, cecum, and ascending colon. At present, the etiology and pathogenesis of colorectal Dieulafoy's disease are still not completely clear. The main clinical manifestation of colorectal Dieulafoy's disease is recurrent and massive hematochezia, and there may be no clinical manifestation during the intermittent period of the hemorrhage. The diagnosis and treatment of Dieulafoy's disease mainly rely on endoscopy, but due to the operating difficulties, clinical characteristics, and other factors, the treatment and diagnosis of this disease remain a challenge to clinicians. In this paper, we will discuss the pathology, etiology, pathogenesis, pathology, diagnosis, and treatment of colorectal Dieulafoy's lesion.
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Affiliation(s)
- Huan-Yu Liu
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Lin Sun
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Yu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Ling-Yun Xv
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Ning-Ning Chen
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Ying-Chao Li
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
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7
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A Retrospective Analysis of Cyanoacrylate Injection versus Hemoclip Placement for Bleeding Dieulafoy's Lesion in Duodenum. Gastroenterol Res Pract 2018; 2018:3208690. [PMID: 29780411 PMCID: PMC5892292 DOI: 10.1155/2018/3208690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/05/2018] [Accepted: 01/28/2018] [Indexed: 12/14/2022] Open
Abstract
Background Duodenal Dieulafoy's lesion (DL) is a rare disease that may lead to lethal hemorrhage in the upper gastrointestinal tract. The best technique for endoscopic intervention still remains unclear. In the present study, we performed a retrospective analysis of cyanoacrylate injection versus hemoclip placement for treating bleeding DLs. Materials and Methods We retrospectively analyzed eighteen patients from three medical centers between October 2008 and February 2016; six patients received cyanoacrylate injection, while hemoclips were placed in 12 patients during the upper gastrointestinal endoscopy. Results All patients received first endoscopic examination and/or endotherapy within 12 hours of admission to hospital. No difference was observed in the primary hemostasis rate or the recurrent hemorrhage rate between the cyanoacrylate injection (CI) group and the hemoclip placement (HP) group, except that in one patient from the HP group melena was found three days after the first endotherapy. This patient received cyanoacrylate injection once again. Conclusion Both cyanoacrylate injection and hemoclip placement are effective in treating duodenal DL, and neither of them causes significant side effects.
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9
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Qiao WG, Ren YT, Liu SD, Zhi FC. Gastroscopy: Advancing further into the horizontal part of the duodenum. J Dig Dis 2017; 18:56-58. [PMID: 27990757 DOI: 10.1111/1751-2980.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/17/2016] [Accepted: 12/08/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Wei Guang Qiao
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Institute of Gastroenterology of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yu Tang Ren
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China
| | - Si De Liu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Institute of Gastroenterology of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Fa Chao Zhi
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Institute of Gastroenterology of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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10
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Emura T, Hosoda K, Harai S, Oyachi N, Suzuki T, Takada K, Kobayashi K, Ikeda H. Dieulafoy lesion in a two-year-old boy: a case report. J Med Case Rep 2016; 10:293. [PMID: 27756373 PMCID: PMC5070190 DOI: 10.1186/s13256-016-1083-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/01/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Massive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping. CASE PRESENTATION A 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis. He had no significant past medical illness, and he was well just before the episode of hematemesis. A clinical examination revealed anemia (hemoglobin, 8.0 g/dl). The rapidly progressive anemia associated with massive hematemesis indicated the presence of an active bleeding in his upper gastrointestinal tract. We performed emergency gastroscopy under general anesthesia. The gastroscopy revealed the presence of an abnormal visible vessel with an adherent clot on the lower body of his stomach. No mucosal abnormality surrounding the lesion was noted; the lesion was thus diagnosed as Dieulafoy lesion. One hemostatic clip was placed on the Dieulafoy lesion and excellent hemostasis was obtained. He recovered without blood transfusion and was discharged 4 days post-endoscopy. He has recovered well with no recurrence of hematemesis. CONCLUSIONS Dieulafoy lesion is rare cause of sudden massive gastrointestinal bleeding in children. Nevertheless, it should be considered a differential diagnosis, even in babies. With advances in gastrointestinal endoscopy, as both a diagnostic and therapeutic modality, laparotomy secondary to gastrointestinal bleeding from Dieulafoy lesion has decreased in pediatric cases. Our case report demonstrates the feasibility of endoscopic hemoclipping for gastric Dieulafoy lesion in a child.
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Affiliation(s)
- Takaki Emura
- Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan.
| | - Kenji Hosoda
- Department of Gastrointestinal Medicine, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan
| | - Shota Harai
- Department of Gastrointestinal Medicine, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan
| | - Noboru Oyachi
- Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan
| | - Takeyuki Suzuki
- Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan
| | - Ken Takada
- Department of Pediatrics, Yamanashi Kosei Hospital, 860 Ochiai, Yamanashi, 405-0033, Japan
| | - Koji Kobayashi
- Department of Pediatrics, Yamanashi Kosei Hospital, 860 Ochiai, Yamanashi, 405-0033, Japan
| | - Hisatake Ikeda
- Department of Pediatrics, Yamanashi Kosei Hospital, 860 Ochiai, Yamanashi, 405-0033, Japan
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Karaahmet F, Kılıncalp S, Coskun Y, Hamamci M, Akinci H, Ustun Y, Simsek Z, Erarslan E, Coban S, Yuksel I. The efficiency of endoclips in maintaining the gastrointestinal bleeding-related Dieulafoy's lesion. Wien Klin Wochenschr 2016; 128:700-705. [PMID: 25854908 DOI: 10.1007/s00508-015-0739-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 01/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dieulafoy's lesion (DL) is a relatively uncommon medical condition characterized by a large tortuous arteriole in the submucosa of any part of gastrointestinal (GI) tract wall that bleeds via erosion likely caused in the submucosal surface by protrusion of the pulsatile arteriole. Compared with other endoscopic hemostatic techniques, clipping alone for DL is limited. AIMS The aim of the present case series study is to identify common clinical and endoscopic features, rates of occurrence, to review the outcome of endoscopic management of upper GI tract DL, and to illustrate the use and the efficiency of endoclips in maintaining the GI bleeding due to DL. PATIENTS AND METHODS This case series was conducted at Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital. The patients who were admitted to the emergency department of Dıskapı Yıldırım Beyazıt Educational and Research Hospital underwent gastrointestinal system (GIS) endoscopy between 2008 and 2013 and were assessed retrospectively. Five cases of GI bleeding related to DL were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS The median number of endoscopic hemoclips application in first endoscopy was 4 (2-9). Rebleeding developed in all patients who had hemoclips applied. Re-endoscopy was performed in three of these patients, which controlled the bleeding. Two patients were transferred to surgery. CONCLUSIONS Combination of endoscopic injection and mechanical therapies seems a suitable method for maintaining upper GIS bleeding due to DL. Also, further studies are needed to better define the best endoscopic approach for the treatment of DL.
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Affiliation(s)
- Fatih Karaahmet
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey.
| | - Serta Kılıncalp
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Yusuf Coskun
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Mevlut Hamamci
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Hakan Akinci
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Yusuf Ustun
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Zahide Simsek
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Elife Erarslan
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Sahin Coban
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Ilhami Yuksel
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
- Department of Gastroenterology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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Seretny M, While B, Manji H. Dieulafoy's Lesion; A Diagnostic ‘Must Know’ for Critical Care Practitioners. J Intensive Care Soc 2016. [DOI: 10.1177/175114370700800218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marta Seretny
- F1 Doctor, Anaesthetics Department Milton Keynes General Hospital
| | - Ben While
- Anaesthetics Department Milton Keynes General Hospital
| | - Hamid Manji
- Consultant Anaesthetist Milton Keynes General Hospital
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Huang Y, Liang J. Progress in treatment of bleeding in Dieulafoy's disease by endoscopic metal titanium clamp. Shijie Huaren Xiaohua Zazhi 2016; 24:2492-2497. [DOI: 10.11569/wcjd.v24.i16.2492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dieulafoy's disease is one of the rare causes of upper gastrointestinal bleeding. Since its pathogenesis is different from that of common gastrointestinal bleeding, traditional acid suppression method has a poor therapeutic effect. Over the past decade, endoscopic hemostatic technologies have developed rapidly and have been vigorously recommended as the preferred method to replace surgery. Among them, endoscopic metal clamp stops bleeding quickly, has a definite curative effect distinctly, and is increasingly advocated by clinicians. However, large-sample studies on endoscopic metal titanium clamp in the treatment of bleeding in Dieulafoy disease are still lacking. This paper systematically reviews the recent advances in the treatment of bleeding in Dieulafoy's disease by endoscopic metal titanium clamp.
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Iwatsuka K, Gotoda T, Kono S, Suzuki S, Yagi Kuwata N, Kusano C, Sugimoto K, Itoi T, Moriyasu F. Clinical Backgrounds and Outcomes of Elderly Japanese Patients with Gastrointestinal Bleeding. Intern Med 2016; 55:325-32. [PMID: 26875955 DOI: 10.2169/internalmedicine.55.5396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Elderly gastrointestinal bleeding (GIB) patients sometimes cannot be discharged home. In some cases, they die after hemostasis, even following appropriate treatment. This study investigates the clinical backgrounds and outcomes of elderly Japanese GIB patients. METHODS The medical records of 185 patients (123 men, 62 women; mean age 68.2 years; range 10-99 years) with GIB symptoms who underwent esophagogastroduodenoscopy or colonoscopy to detect or treat the source of GIB were retrospectively reviewed. We compared the outcomes between patients ≤70 (n=85) and >70 (n=100) years. The clinical backgrounds of the patients who died or changed hospitals to undergo rehabilitation or receive palliative care were evaluated, as were the association of four factors with these poor outcomes: GIB (re-bleeding or uncontrolled bleeding), endoscopic procedure-related complications, exacerbation of the pre-existing comorbidity, and any complications that were not directly related to GIB. RESULTS Of the patients ≤70 and >70 years of age, three (3.5%) and 17 (17.0%), respectively, were transferred to another hospital (p=0.003). One (1.2%) and five (5.0%), respectively, died (p=0.144). All three patients ≤70 years old that changed hospitals did so because their comorbidities became worse. The reasons for changing hospitals in the 17 patients >70 years of age included exacerbation of a pre-existing comorbidity (41.1%, 7/17), other complications (35.4%, 6/17), GIB itself (17.6%, 3/17), and endoscopic procedure-related complications (5.9%, 1/17). CONCLUSION Although non-elderly and elderly GIB patients had similar mortality rates, many more elderly patients could not be discharged home for various reasons.
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Affiliation(s)
- Kunio Iwatsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
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Ji JS, Kim HK, Kim SS, Chae HS, Cho H, Cho YS. Clinical outcome of endoscopic management of duodenal Dieulafoy’s lesions: endoscopic band ligation versus endoscopic hemoclip placement. Surg Endosc 2015; 30:3526-31. [DOI: 10.1007/s00464-015-4642-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/22/2015] [Indexed: 12/31/2022]
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ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding. Am J Gastroenterol 2015; 110:1265-87; quiz 1288. [PMID: 26303132 DOI: 10.1038/ajg.2015.246] [Citation(s) in RCA: 373] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/01/2015] [Indexed: 02/06/2023]
Abstract
Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.
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Li SL, Jing FY, Ma LL, Guo LL, Na F, An SL, Ye Y, Yang JM, Bao M, Kang D, Sun XL, Deng YJ. Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:4649-56. [PMID: 26316703 PMCID: PMC4541538 DOI: 10.2147/dddt.s90209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The etiology and pathogenesis of hemorrhoids is unclear, although hemorrhoids are a worldwide disease in men and women, with peak prevalence at 45–65 years of age. Hemorrhoidal cushions as the anal venous plexi are normal anatomical structures from infancy. This study attempts to reveal the angiodysplasia and other pathological changes in association with different degrees of symptomatic hemorrhoids. Materials and methods A total of 281 patients with internal hemorrhoids from degree I to IV underwent hemorrhoidectomy. The vascular changes were analyzed by microscopic assessment and software analysis, with Masson’s trichrome, CD34, and smooth muscle actin. Results The hemorrhoidal tissues exhibited abnormal vessels in the mucosae and submucosae that we termed them as myofibrotic malformation vessels (MMVs). MMVs are not ascribed to arteries or veins because they exhibit enlarged and tortuous lumens with smooth muscle dysplasia and fibrotic deposition in the walls without overlying mucosal ulceration. The muscularis mucosae also showed smooth muscle dysplasia and fibrosis, even if it were interrupted by the intruding MMVs. The statistical data indicated that the severity of all the changes correlate positively with the progression of hemorrhoids (P<0.001). Hemorrhoidal patients are prone for reoccurrence even with prolapsing hemorrhoid when compared with the conventional hemorrhoidectomy. Multiple logistic regression analysis showed that MMVs in mucosal propria, mean thickness of mucosal muscularis layer, and fibrotic changes in MMV were independent risk factors for MMVs in hemorrhoidal disease. Conclusion MMVs and muscularis mucosae dysplasia reciprocally contribute to hemorrhoidal exacerbation. The novel findings of this study propose that the characteristic features of MMVs and muscularis mucosae dysplasia of the anorectal tube ultimately cause symptomatic hemorrhoids, which could affect the clinical management of hemorrhoidal disease through the use of surgery to target the malformed vessels.
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Affiliation(s)
- Sheng-Long Li
- Department of Anorectal Surgery, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China
| | - Fang-Yan Jing
- Department of Anorectal Surgery, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China ; Department of Pathology, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China ; Department of Pathology, School of Basic Medical Sciences, Zengcheng, Guangzhou, People's Republic of China
| | - Li-Li Ma
- Department of Pathology, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China ; Department of Pathology, School of Basic Medical Sciences, Zengcheng, Guangzhou, People's Republic of China
| | - Li-Li Guo
- Department of Pathology, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China ; Department of Pathology, School of Basic Medical Sciences, Zengcheng, Guangzhou, People's Republic of China
| | - Feng Na
- Department of Pathology, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China ; Department of Pathology, School of Basic Medical Sciences, Zengcheng, Guangzhou, People's Republic of China
| | - Sheng-Li An
- Department of Biostatistics, Southern Medical University, Zengcheng, Guangzhou, People's Republic of China
| | - Yan Ye
- Department of General Surgery, Xintang Hospital, Zengcheng, Guangzhou, People's Republic of China
| | - Jun-Ming Yang
- Department of Anorectal Surgery, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China
| | - Ming Bao
- Department of Anorectal Surgery, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China
| | - Dong Kang
- Department of Anorectal Surgery, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China
| | - Xiao-Lan Sun
- Department of Anorectal Surgery, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China
| | - Yong-Jian Deng
- Department of Pathology, Nanfang Hospital, Zengcheng, Guangzhou, People's Republic of China ; Department of Pathology, School of Basic Medical Sciences, Zengcheng, Guangzhou, People's Republic of China
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Abstract
Dieulafoy's lesion (DL) is a persistently wide caliber artery that is observed more frequently at the fifth decade of life in the male population with multiple comorbidities. There are a variety of endoscopic therapies that have been used to treat DL; however, there are no clear guidelines on the best treatment modality. This article systematically reviews the diagnosis, the most commonly reported therapies of DL, and offers a suggested algorithm based upon efficacy of treatment such as initial hemostasis, rebleeding rates, and mortality.
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Outcomes in Dieulafoy's Lesion: A 10-Year Clinical Review. Dig Dis Sci 2015; 60:2097-103. [PMID: 25663242 DOI: 10.1007/s10620-015-3568-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/28/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Dieulafoy's lesion (DL) is a rare, but serious cause of gastrointestinal bleeding, most frequently treated with endoscopic therapy. We examined 10 years of data to assess clinical outcomes in DL. METHODS Data were captured by retrospective chart review to assess 109 patients treated endoscopically for bleeding DL from 2003 to 2013. Data collected included demographics, comorbidities, presenting symptoms, risk factors, laboratory values, treatment, rebleeding, surgical intervention, and mortality. Treatment success, rebleeding rates, and mortality were the main outcomes measured. RESULTS Of 109 patients with bleeding DL, 54 % were male and 46 % were female. Mean age was 79.4 years; mean follow-up duration was 40.4 ± 35.8 months. Clinical presentation for most patients included melena, hematemesis, hematochezia, and/or anemia with approximately one-third of patients also experiencing anemia-related symptoms. Most lesions were located in stomach (53 %) followed by duodenum/jejunum (33 %) and large intestine (13 %). Thermal endoscopic therapy (70 %) was the most frequently performed procedure followed by injection (46 %) and mechanical (46 %) endoscopy therapy at equal frequency. Combined therapy (51 %) was common, with over half of patients undergoing two or more endoscopic modalities simultaneously. The finding that only 11 (10 %) patients had rebleeding from DL suggests that endoscopic therapy resulted in successful hemostasis in the remaining 98 patients (90 %) during follow-up. Mortality related to DL was low. CONCLUSIONS Most patients with bleeding DL presented with symptoms of acute bleeding, but many had symptoms suggesting subacute or chronic bleeding. Endoscopic therapy resulted in successful hemostasis in approximately 90 % of patients during follow-up. Rebleeding was rare and particularly uncommon in those treated with combined endoscopic therapy.
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Shin HJ, Ju JS, Kim KD, Kim SW, Kang SH, Kang SH, Moon HS, Sung JK, Jeong HY. Risk Factors for Dieulafoy Lesions in the Upper Gastrointestinal Tract. Clin Endosc 2015; 48:228-33. [PMID: 26064823 PMCID: PMC4461667 DOI: 10.5946/ce.2015.48.3.228] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/13/2014] [Accepted: 10/19/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS The purpose of this study is to verify the risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract. METHODS A case-control study was performed by reviewing the electronic medical records of 42 patients who were admitted to a tertiary medical center in the Daejeon region for Dieulafoy lesions from September 2008 to October 2013, and the records of 132 patients who were admitted during the same period and who underwent endoscopic examination for reasons other than bleeding. We analyzed clinical and endoscopic findings retrospectively, and searched for risk factors associated with Dieulafoy lesion formation. RESULTS All 42 patients diagnosed with Dieulafoy lesion had accompanying bleeding, and the location of the bleeding was proximal in 25 patients (59.5%), the middle portion in seven patients (16.7%), and distal in 10 patients (23.8%). Antiplatelet agents (p=0.022) and alcohol (p=0.001) use showed statistically significant differences between the two groups. The odds ratios (95% confidence intervals) of the two factors were 2.802 (1.263 to 6.217) and 3.938 (1.629 to 9.521), respectively. CONCLUSIONS This study showed that antiplatelet agents and alcohol consumption were risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract.
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Affiliation(s)
- Hae Jin Shin
- Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jong Seok Ju
- Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ki Dae Kim
- Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seok Won Kim
- Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sung Hoon Kang
- Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun Hyung Kang
- Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hee Seok Moon
- Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Kyu Sung
- Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Yong Jeong
- Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Jeon HK, Kim GH. Endoscopic Management of Dieulafoy's Lesion. Clin Endosc 2015; 48:112-20. [PMID: 25844338 PMCID: PMC4381137 DOI: 10.5946/ce.2015.48.2.112] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/02/2014] [Accepted: 11/03/2014] [Indexed: 12/11/2022] Open
Abstract
A Dieulafoy's lesion is a vascular abnormality consisting of a large caliber-persistent tortuous submucosal artery. A small mucosal defect with the eruption of this protruding vessel can cause bleeding. In fact, a Dieulafoy's lesion is a relatively rare but potentially life-threatening condition. It accounts for 1% to 2% of cases of acute gastrointestinal bleeding. Although there is no consensus on the treatment of Dieulafoy's lesions; treatment options depend on the mode of presentation, site of the lesion, and available expertise. Endoscopic therapy is usually successful in achieving primary hemostasis, with hemostasis success rates reaching 75% to 100%. Although various therapeutic endoscopic methods are used to control bleeding in Dieulafoy's lesions, the best method for endoscopic intervention is not clear. Combination endoscopic therapy is known to be superior to monotherapy because of a lower rate of recurrent bleeding. In addition, mechanical therapies including hemostatic clipping and endoscopic band ligation are more effective and successful in controlling bleeding than other endoscopic methods. Advances in endoscopic techniques have reduced mortality in patients with Dieulafoy's lesion-from 80% to 8%-and consequently, the need for surgical intervention has been reduced. Currently, surgical intervention is used for cases that fail therapeutic endoscopic or angiographic interventions.
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Affiliation(s)
- Hye Kyung Jeon
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Lesión de Dieulafoy. Presentación de 2 casos. ENDOSCOPIA 2015. [DOI: 10.1016/j.endomx.2015.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Higuchi T, Iwakiri R, Hara M, Shimoda R, Sakata Y, Nakayama A, Nio K, Yamaguchi S, Yamaguchi D, Watanabe A, Akutagawa T, Sakata H, Fujimoto K. Low-dose aspirin and comorbidities are significantly related to bleeding peptic ulcers in elderly patients compared with nonelderly patients in Japan. Intern Med 2014; 53:367-73. [PMID: 24583422 DOI: 10.2169/internalmedicine.53.0603] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The present study was conducted using data accumulated from our earlier study of bleeding peptic ulcers, focusing on elderly patients. METHODS A total of 461 patients with bleeding peptic ulcers underwent emergency endoscopy at Saga Medical School Hospital between 1999 and 2011. Risk factors for bleeding peptic ulcers were compared between two groups: an elderly group (≥65 years old) and a nonelderly group (<65 years old). The relationship between drug use and age was examined using multiple logistic regression models. In the elderly group, the factors were compared between Period I (1999-2005) and Period II (2006-2011). RESULTS The proportion of men and the incidence of Helicobacter pylori infection were lower in the elderly group than in the nonelderly group. The use of low-dose aspirin, antithrombotic drugs and corticosteroids, but not nonsteroidal anti-inflammatory drugs, was higher in the elderly group. A multiple logistic regression analysis of prescribed medications indicated that low-dose aspirin was more frequently used in the elderly group. The rate of comorbidities was higher and the hemoglobin levels were lower in the elderly group. The rates of rebleeding within one week and death within one month did not differ in the elderly group. Compared with that observed in Period I, the incidence of Helicobacter pylori infection was decreased and the rate of comorbidities was increased in Period II. CONCLUSION This study indicates that factors related to bleeding peptic ulcers in elderly patients have shifted from Helicobacter pylori infection to comorbidities associated with low-dose aspirin, suggesting a close relationship between low-dose aspirin therapy and comorbidities in elderly patients with peptic ulcers.
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Affiliation(s)
- Toru Higuchi
- Departments of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Japan
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Alomari AI, Fox V, Kamin D, Afzal A, Arnold R, Chaudry G. Embolization of a bleeding Dieulafoy lesion of the duodenum in a child. Case report and review of the literature. J Pediatr Surg 2013; 48:e39-41. [PMID: 23331838 DOI: 10.1016/j.jpedsurg.2012.10.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/20/2012] [Accepted: 10/23/2012] [Indexed: 02/07/2023]
Abstract
We report an adolescent with chronic, recurrent upper gastrointestinal bleeding in whom extensive prior investigations failed to reveal the source of bleeding. Angiography accurately identified a bleeding Dieulafoy lesion of the duodenum which was successfully embolized. The clinical history, angiographic appearances and treatment of this rare lesion are presented.
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Affiliation(s)
- Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
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Jamanca-Poma Y, Velasco-Guardado A, Piñero-Pérez C, Calderón-Begazo R, Umaña-Mejía J, Geijo-Martínez F, Rodríguez-Pérez A. Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy's lesion. World J Gastroenterol 2012; 18:5734-8. [PMID: 23155314 PMCID: PMC3484342 DOI: 10.3748/wjg.v18.i40.5734] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/26/2012] [Accepted: 07/28/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding.
METHODS: Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy’s lesion (DL) from 2005 to 2011. We analyzed the demographic characteristics of the patients, risk factors for gastrointestinal bleeding, endoscopic findings, characteristics of the endoscopic treatment, and the recurrence of bleeding. We included cases in which endoscopy described a lesion compatible with Dieulafoy. We excluded patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures.
RESULTS: Twenty-nine patients with DL were identified. Most of them were men with an average age of 71.5 years. Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy. The most common location for DL was the stomach (51.7%). The main type of bleeding was oozing in 65.5% of cases. In 27.6% of cases, there was arterial (spurting) bleeding, and 6.9% of the patients presented with an adherent clot. A single endoscopic treatment was applied to nine patients (31%); eight of them with adrenaline and one with argon, while 69% of the patients received combined treatment. Six patients (20.7%) presented with recurrent bleeding at a median of 4 d after endoscopy (interquartile range = 97.75). Within these six patients, the new endoscopic treatment obtained a therapeutic success of 100%. The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding (50% vs 33.3% for other type of bleeding) [P = 0.024, odds ratio (OR) = 8.5, 95% CI = 1.13-63.87]. The use of combined endoscopic treatment prevented the recurrence of bleeding (10% vs 44.4% of single treatment) (P = 0.034, OR = 0.14, 95% CI = 0.19-0.99).
CONCLUSION: Endoscopic treatment of DL is safe and effective. Adrenaline monotherapy and arterial (spurting) bleeding are associated with a high rate of bleeding recurrence.
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Ahn DW, Lee SH, Park YS, Shin CM, Hwang JH, Kim JW, Jeong SH, Kim N, Lee DH. Hemostatic efficacy and clinical outcome of endoscopic treatment of Dieulafoy's lesions: comparison of endoscopic hemoclip placement and endoscopic band ligation. Gastrointest Endosc 2012; 75:32-8. [PMID: 22100302 DOI: 10.1016/j.gie.2011.08.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 08/20/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND The most suitable mechanical endoscopic hemostasis for a bleeding Dieulafoy's lesion (DL) is not yet well established. OBJECTIVE To compare the hemostatic efficacy and clinical outcome of endoscopic hemoclip placement (EHP) and endoscopic band ligation (EBL). DESIGN Retrospective, single-center study. SETTING A tertiary-care referral university hospital. PATIENTS Sixty-six patients who received mechanical endoscopic hemostasis for bleeding DLs. INTERVENTIONS Endoscopic hemostasis. MAIN OUTCOME MEASUREMENT Primary hemostasis and rebleeding rates. RESULTS DLs accounted for 3.8% of cases of acute nonvariceal upper GI bleeding during the study period. Active bleeding from DLs was noted in 34 patients (51.5%). EHP and EBL were performed as a method of endoscopic hemostasis in 34 and 32 patients, respectively. There were no significant differences between the 2 groups with respect to baseline characteristics (except comorbidities) and endoscopic features of DLs. Primary hemostasis was achieved in all 66 patients (100%). There were 6 cases of recurrent bleeding: 5 (14.7%) and 1 (3.1%) in the EHP and EBL groups, respectively. Secondary hemostasis was achieved with endoscopic treatment and angiographic embolization in 5 patients and 1 patient, respectively, and no patients required surgery. The mean procedure time of endoscopic hemostasis was significantly longer in the EHP group (19.1 vs 11.5 minutes, P = .015). There was no bleeding-related mortality. LIMITATIONS Retrospective analysis. CONCLUSIONS Both EHP and EBL are suitable for the treatment of bleeding DLs. EBL can be used as an initial hemostatic method for bleeding DLs because of a favorable clinical outcome comparable to that with EHP and a shorter procedure time.
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Affiliation(s)
- Dong-Won Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Sevilla Chica FI, Bernet Vegué L, Martínez Benaclocha M, Torró Richart J. [Dieulafoy's lesion of the gallbladder as a cause of hemobilia with hemoperitoneum]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:690-3. [PMID: 22055829 DOI: 10.1016/j.gastrohep.2011.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/08/2011] [Accepted: 07/14/2011] [Indexed: 12/20/2022]
Abstract
Dieulafoy's lesion is an uncommon vascular anomaly causing massive gastrointestinal hemorrhage, characterized by bleeding from an arteriole that protrudes through a tiny mucosal defect. Although Dieulafoy's lesion was initially described in the stomach and upper gastrointestinal tract, cases have also been reported in the colon, rectum and anal canal. We report the first case of Dieulafoy's lesion in the gallbladder, which presented as massive peritoneal bleeding. We describe the clinical and pathological characteristics of this unusual entity, as well as the approach to its diagnosis and treatment.
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[Retroperitoneal hematoma after treatment of Dieulafoy's lesion of the duodenum]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:532-4. [PMID: 21777994 DOI: 10.1016/j.gastrohep.2011.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/10/2011] [Accepted: 05/16/2011] [Indexed: 12/28/2022]
Abstract
Dieulafoy's lesion is an uncommon cause of brisk arterial bleeding from the gastrointestinal tract that can have severe consequences such as rebleeding and hypotension if left untreated. The authors report the case of an elderly woman with several comorbidities who presented with duodenal bleeding caused by a Dieulafoy lesion. The lesion was treated endoscopically and was subsequently complicated by the formation of a retroperitoneal hematoma. Given the surgical risk, the authors opted to retreat endoscopically, which proved to be a reasonable approach in this particular patient.
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Rahbour G, Ullah MR, Siddiqui M, Agha R, Kerwat R. Dieulafoy lesion endoscopically rubber banded, with further severe haematemesis requiring emergency laparotomy - Case report. Int J Surg Case Rep 2011; 2:154-6. [PMID: 22096712 PMCID: PMC3199629 DOI: 10.1016/j.ijscr.2011.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 04/06/2011] [Accepted: 04/17/2011] [Indexed: 02/06/2023] Open
Abstract
Dieulafoy lesion is a rare cause of massive gastrointestinal haemorrhage that can be fatal. We report a case of a sixty-year-old lady who presented to the emergency department with haematemesis and melaena. During oesophagogastroduodenoscopy (OGD), an active bleeding vessel was seen on the lesser curvature of the stomach, near the gastro-oesophageal junction and a diagnosis of Dieulafoy's lesion made. The lesion was managed with the application of two rubber bands. Our patient re-presented to the emergency department ten days later with severe haematemesis requiring an emergency laparotomy.A search of the entire English literature using PubMed with the phrase 'Dieulafoy' has been performed. Papers were reviewed in relation to management of this lesion with rubber banding via endoscopy. The current available haemostatic methods are described.
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Affiliation(s)
- Goher Rahbour
- South London Healthcare NHS Trust, Queen Mary's Sidcup Hospital, London DA14 6LT, United Kingdom
| | - Mohammad Rehan Ullah
- South London Healthcare NHS Trust, Queen Mary's Sidcup Hospital, London DA14 6LT, United Kingdom
| | | | - Riaz Agha
- National Institute for Health and Clinical Excellence Scholar, London WC1V 6NA, United Kingdom
| | - Rajab Kerwat
- South London Healthcare NHS Trust, Queen Mary's Sidcup Hospital, London DA14 6LT, United Kingdom
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Abstract
AIM: To investigate the incidence, location, clinical presentation, diagnosis and effectiveness of endoscopic treatment of gastric Dieulafoy’s lesion (DL) in China.
METHODS: All patients who received emergency upper gastrointestinal (GI) endoscopy due to gastric DL from February 2000 to August 2008 at GI endoscopy center of Renmin Hospital of Wuhan University were included in this study. The clinical presentation, medical history, location and characteristics of DL methods and effectiveness of therapy of patients with DL were retrospectively analysed by chart reviews. Long-term follow-up data were collected at outpatient clinics or telephone interviews.
RESULTS: Fifteen patients were diagnosized with DL, which account for 1.04% of the source of bleeding in acute non-variceal upper GI bleeding. Common comorbidities were found in one patient with hypertension and diabetic mellitus. Hemoclip or combined therapy with hemoclip produced primary hemostasis in 92.8% (13/14) of patients.
CONCLUSION: DL is uncommon but life-threatening in China. Hemoclip proved to be safe and effective in controlling bleeding from DL.
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Lim W, Kim TO, Park SB, Rhee HR, Park JH, Bae JH, Jung HR, Kim MR, Lee N, Lee SM, Kim GH, Heo J, Song GA. Endoscopic treatment of dieulafoy lesions and risk factors for rebleeding. Korean J Intern Med 2009; 24:318-22. [PMID: 19949729 PMCID: PMC2784974 DOI: 10.3904/kjim.2009.24.4.318] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 04/18/2009] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Dieulafoy lesions are an important cause of upper gastrointestinal bleeding. The purpose of this study was to assess the efficacy of endoscopic treatment for these lesions and to identify the possible predictive factors for rebleeding associated with clinical and endoscopic characteristics. METHODS Records from 44 patients admitted with Dieulafoy bleeding between January 2006 and December 2007 were reviewed. We retrospectively analyzed the clinical and endoscopic findings and then correlated the rebleeding risk factors with Dieulafoy lesions. RESULTS Primary hemostasis was achieved by endoscopic treatment in 39 patients (88.6%). There were no significant differences between the rebleeding and non-rebleeding groups with respect to age, gender, initial hemoglobin levels, presence of shock, concurrent disease, location of bleeding, or initial hemostatic treatment methods. However, the use of non-steroidal anti-inflammatory drugs or anticoagulants (p=0.02) and active stages in the Forrest classification (p<0.01) were risk factors for rebleeding after endoscopic therapy. CONCLUSIONS Endoscopic therapy is effective and safe for treating Dieulafoy lesions, and it has both short- and long-term benefits. Early identification of risk factors such as the use of non-steroidal anti-inflammatory drugs or anticoagulants and the Forrest classification of bleeding predict the outcome of Dieulafoy lesions.
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Affiliation(s)
- Won Lim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Ha Rin Rhee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Jin Hyun Park
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Jung Ho Bae
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Hong Ryeul Jung
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Mi Ra Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - NaRiA Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Sun Mi Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Jeong Heo
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
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Lim W, Kim TO, Park SB, Rhee HR, Park JH, Bae JH, Jung HR, Kim MR, Lee N, Lee SM, Kim GH, Heo J, Song GA. Endoscopic treatment of dieulafoy lesions and risk factors for rebleeding. Korean J Intern Med 2009. [PMID: 19949729 DOI: 10.3904/kjim.2009.24.4318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Dieulafoy lesions are an important cause of upper gastrointestinal bleeding. The purpose of this study was to assess the efficacy of endoscopic treatment for these lesions and to identify the possible predictive factors for rebleeding associated with clinical and endoscopic characteristics. METHODS Records from 44 patients admitted with Dieulafoy bleeding between January 2006 and December 2007 were reviewed. We retrospectively analyzed the clinical and endoscopic findings and then correlated the rebleeding risk factors with Dieulafoy lesions. RESULTS Primary hemostasis was achieved by endoscopic treatment in 39 patients (88.6%). There were no significant differences between the rebleeding and non-rebleeding groups with respect to age, gender, initial hemoglobin levels, presence of shock, concurrent disease, location of bleeding, or initial hemostatic treatment methods. However, the use of non-steroidal anti-inflammatory drugs or anticoagulants (p=0.02) and active stages in the Forrest classification (p<0.01) were risk factors for rebleeding after endoscopic therapy. CONCLUSIONS Endoscopic therapy is effective and safe for treating Dieulafoy lesions, and it has both short- and long-term benefits. Early identification of risk factors such as the use of non-steroidal anti-inflammatory drugs or anticoagulants and the Forrest classification of bleeding predict the outcome of Dieulafoy lesions.
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Affiliation(s)
- Won Lim
- Department of Internal Medicine, Pusan National University College of Medicine, Seo-gu, Busan, Korea
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Endoscopic band ligation for nonvariceal bleeding: a review. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 22:748-52. [PMID: 18818787 DOI: 10.1155/2008/165264] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Is endoscopic band ligation superior to injection therapy for Dieulafoy lesion? Surg Endosc 2009; 23:1465-9. [PMID: 19125307 DOI: 10.1007/s00464-008-0255-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 10/17/2008] [Accepted: 11/05/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dieulafoy lesion is a rare but serious cause of gastrointestinal system bleeding. An aberrant submucosal artery, which was described in 1884, causes the bleeding. The lesion can be located anywhere in the gastrointestinal tract but is most commonly found in the proximal stomach up to 6 cm from the gastroesophageal junction. Increased experience in endoscopy has led to an increased frequency of its proper diagnosis. Various methods are used to achieve successful hemostasis by endoscopy in Dieulafoy lesion; however, comparative studies about the success rates of these methods are still needed. In this study, we compared two of these endoscopic hemostatic methods: band ligation, and injection therapy in Dieulafoy lesions. METHODS In this prospective study, 18 patients admitted to the Emergency Surgical Unit between January 2002 and December 2005 with upper gastrointestinal bleeding diagnosed as Dieulafoy lesion were included. Diagnose of Dieulafoy lesion was made at initial or second-look endoscopy. Patients were randomized in two groups according to therapy method: injection therapy and band ligation groups. Therapy was applied immediately after recognizing the lesion at the same endoscopic procedure. Two groups were compared regarding demographical data, presence of comorbid diseases, history of medication and previous gastrointestinal system bleeding, hemodynamic status, laboratory values, need for transfusion, endoscopic findings, success rate of the treatment method, mean hospital stay, complications, and recurrence of bleeding. RESULTS Of 588 patients admitted with upper gastrointestinal hemorrhage, Dieulafoy lesion was recognized in 18 cases (3.1%) at initial or second-look endoscopy. All patients were men with a mean age of 62.8 (range, 30-80) years. Band ligation was applied to ten patients and the remaining eight were treated by injection therapy. During the follow-up period, rebleeding occurred in six of the patients (75%) with injection therapy, whereas no rebleeding occurred for the patients in the band ligation group. The rebleeding rate and mean hospital stay was significantly higher for the injection therapy group. CONCLUSIONS Our study suggests that of the endoscopic treatment methods, band ligation is superior to injection therapy for the treatment Dieulafoy lesions.
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Gerson L, Kamal A. Cost-effectiveness analysis of management strategies for obscure GI bleeding. Gastrointest Endosc 2008; 68:920-36. [PMID: 18407270 DOI: 10.1016/j.gie.2008.01.035] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 01/17/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Of patients who are seen with GI hemorrhage, approximately 5% will have a small-bowel source. Management of these patients entails considerable expense. We performed a decision analysis to explore the optimal management strategy for obscure GI hemorrhage. METHODS We used a cost-effectiveness analysis to compare no therapy (reference arm) to 5 competing modalities for a 50-year-old patient with obscure overt bleeding: (1) push enteroscopy, (2) intraoperative enteroscopy, (3) angiography, (4) initial anterograde double-balloon enteroscopy (DBE) followed by retrograde DBE if the patient had ongoing bleeding, and (5) small-bowel capsule endoscopy (CE) followed by DBE guided by the CE findings. The model included prevalence rates for small-bowel lesions, sensitivity for each intervention, and the probability of spontaneous bleeding cessation. We examined total costs and quality-adjusted life years (QALY) over a 1-year time period. RESULTS An initial DBE was the most cost-effective approach. The no-therapy arm cost $532 and was associated with 0.870 QALYs compared with $2407 and 0.956 QALYs for the DBE approach, which resulted in an incremental cost-effectiveness ratio of $20,833 per QALY gained. Compared to the DBE approach, an initial CE was more costly and less effective. The initial DBE arm resulted in an 86% bleeding cessation rate compared to 76% for the CE arm and 59% for the no-therapy arm. The model results were robust to a wide range of sensitivity analyses. LIMITATIONS The short time horizon of the model, because of the lack of long-term data about the natural history of rebleeding from small-intestinal lesions. CONCLUSIONS An initial DBE is a cost-effective approach for patients with obscure bleeding. However, capsule-directed DBE may be associated with better long-term outcomes because of the potential for fewer complications and decreased utilization of endoscopic resources.
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Affiliation(s)
- Lauren Gerson
- Division of Gastroenterology and Hepatology Stanford University School of Medicine, Stanford, California 94305-5202, USA
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Endoscopic clipping for the management of gastrointestinal bleeding. ACTA ACUST UNITED AC 2008; 5:559-68. [PMID: 18711412 DOI: 10.1038/ncpgasthep1233] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 07/04/2008] [Indexed: 02/06/2023]
Abstract
Endoscopic clipping is a safe and effective technique for the treatment of various bleeding gastrointestinal lesions. Randomized controlled trials and a meta-analysis have shown comparable efficacy between clipping and conventional contact thermal therapy for definitive hemostasis of nonvariceal upper gastrointestinal hemorrhage. Clipping also seems to be efficacious for selected lower gastrointestinal bleeding lesions, such as diverticular bleeding and postpolypectomy bleeding. Proficiency in clip application and endoscopic identification of lesions that are amenable to clipping are key determinants of a successful outcome.
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Cui J, Liu YX, Wu CR, Huang LY. Endoscopic therapy for gastrointestinal bleeding due to Dieulafoy lesion: an analysis of 77 cases. Shijie Huaren Xiaohua Zazhi 2008; 16:1946-1950. [DOI: 10.11569/wcjd.v16.i17.1946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess endoscopic homeostasis method for gastrointestinal bleeding due to Dieulafoy lesion.
METHODS: Seventy-seven patients with gastrointestinal bleeding due to Dieulafoy lesion were treated with the following three kinds of endoscopic homeostasis methods: injecting therapy with aethoxysclerol (36 cases), endoscopic hemoclip homeostasis (21 cases), hemoclip hemostasis in combination with injecting therapy of aethoxysclerol (20 cases). The successful homeostasis rates and complication rates of the three approaches were assessed.
RESULTS: Successful homeostasis rates of the three approaches were 80.6%(29/36), 95.2%(20/21) and 100(20/20), respectively and a significant difference was detected (P < 0.05). 7 cases who failed with injecting therapy of aethoxysklerol were treated with hemoclip hemastasis. 5 cases succeeded and 2 cases failed and underwent further surgical operation. 1 case who failed with hemoclip homeostasis was later treated with injecting therapy of aethoxysklerol and bleeding was controlled. No serious complications including perforation occurred in patients using endoscopic hemostasis method and no re-bleeding occurred during half-year follow-up.
CONCLUSION: Hemoclip hemostasis in combination with injecting therapy of aethoxysklerol is the most effective method for gastrointestinal bleeding due to Dieulafoy lesion.
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Borda Celaya F, Amorena Muro E, Juanmartiñena Fernández F, Javier Jiménez Pérez F, José Vila Costas J, Arin Letamendia A. ¿Presenta características diferenciales la hemorragia digestiva alta por lesión de Dieulafoy? GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:335-40. [DOI: 10.1157/13123600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Nagri S, Anand S, Arya Y. Clinical presentation and endoscopic management of Dieulafoy’s lesions in an urban community hospital. World J Gastroenterol 2007; 13:4333-5. [PMID: 17708606 PMCID: PMC4250859 DOI: 10.3748/wjg.v13.i32.4333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify rates of occurrence, common clinical and endoscopic features, and to review the outcome of endoscopic management of Dieulafoy’s lesions in the upper gastrointestinal (GI) tract in an urban community hospital setting.
METHODS: Endoscopic data from esophagogastroduodenoscopies (EGDs), done at Wyckoff Heights Medical Center, Brooklyn, NY between 2000 and 2006 were reviewed to identify patients with Dieulafoy’s lesions. Demographic data, medical history, examination findings, lab data, endoscopic findings and details of therapy for patients treated for Dieulafoy’s lesions were reviewed retrospectively.
RESULTS: Dieulafoy’s lesions were documented to be the cause of bleeding in approximately 1% of patients presenting with upper gastrointestinal bleeding, while they were detected in only 2 patients when the indications for EGDs were different from active GI bleeding. When we analyzed EGDs performed in patients above age 65 years presenting with gastrointestinal bleeding, prevalence of Dieulafoy’s lesions approached 10 percent. The most common location of the lesion was the body of stomach (7), followed by the cardia (4) and the esophagus (2). One patient had this lesion in the fundus and one patient in the duodenal apex. All patients were initially treated endoscopically with epinephrine injection, in eight cases heater probe was applied following epinephrine and endoscopic clips were applied in two cases. All but one of the patients did well in near and intermediate term follow-up (average follow-up period of 18 mo). One patient died of multi-organ failure during the same hospital stay. Average length hospital stay was 7 d.
CONCLUSION: Community hospital gastroenterologists and endoscopists should be aware that Dieulafoy's lesions are an uncommon cause of upper GI bleeding among elderly patients. Early accurate diagnosis through emergent endoscopy and endoscopic therapy, especially in patients with multiple co-morbid conditions, can be very effective and life saving.
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Affiliation(s)
- Srikrishna Nagri
- Department of Gastroenterology, Brooklyn Hospital Center, Brooklyn, NY 11201, United States.
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Park WG, Yeh RW, Triadafilopoulos G. Injection therapies for nonvariceal bleeding disorders of the GI tract. Gastrointest Endosc 2007; 66:343-54. [PMID: 17643711 DOI: 10.1016/j.gie.2006.11.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 11/09/2006] [Indexed: 02/08/2023]
Affiliation(s)
- Walter G Park
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California 94305, USA
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Iacopini F, Petruzziello L, Marchese M, Larghi A, Spada C, Familiari P, Tringali A, Riccioni ME, Gabbrielli A, Costamagna G. Hemostasis of Dieulafoy's lesions by argon plasma coagulation (with video). Gastrointest Endosc 2007; 66:20-6. [PMID: 17591469 DOI: 10.1016/j.gie.2006.11.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 11/10/2006] [Indexed: 02/06/2023]
Abstract
BACKGROUND A Dieulafoy's lesion is a submucosal artery that may erode the epithelium and lead to severe hemorrhages. The safety and efficacy of argon plasma coagulation (APC) for the hemostasis of these lesions has not been studied. OBJECTIVE To evaluate efficacy of APC alone in the hemostasis of Dieulafoy's lesions. DESIGN A retrospective analysis of hemostasis by chart review, with long-term follow-up by outpatient visit or phone interview. SETTING An academic hospital with 24-hour endoscopic service availability. PATIENTS All patients with acute bleeding from a Dieulafoy's lesion treated with APC. INTERVENTIONS Hemostasis was attempted with 2.3-mm APC probes, with settings varying from 40 W to 60 W, according to lesion location. MAIN OUTCOME MEASUREMENTS Initial hemostasis, recurrent bleeding, and 30-day mortality rates. RESULTS Twenty-three Dieulafoy's lesions were treated with APC, which represented 85% of all such lesions observed. Severe comorbidities and abnormal coagulation were present in 39% and 22%, respectively. Dieulafoy's lesions were located in the upper-GI tract in 20 patients (87%). Active bleeding was found in 20 patients (87%), a nonbleeding visible vessel was found in 2 patients (9%), and a minute mucosal defect below an adherent clot was found in 1 (4%). Initial hemostasis was achieved in all patients, without complications. An injection of an average volume of 3 mL of 1:10,000 epinephrine solution preceded APC in 3 cases for the identification of the bleeding lesion. Recurrent bleeding occurred in a patient after 48 hours; no bleeding-related deaths were observed during a median follow-up of 29 months. LIMITATIONS Retrospective study. CONCLUSIONS Dieulafoy's lesions can be successfully managed by APC alone.
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Affiliation(s)
- Federico Iacopini
- Digestive Endoscopy Unit, Department of Surgery, Catholic University, Rome, Italy
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