Endoscopic management of Dieulafoy lesions in acute nonvariceal upper gastrointestinal bleeding.
Dieulafoy lesion is an unusual but important cause of upper gastrointestinal bleeding. The study retrospectively reviewed 29 patients (2.1%) with Dieulafoy lesions of 1393 acute nonvariceal upper gastrointestinal bleeding episodes from October 1999 to May 2001. Nineteen patients (66%) were male and the median age was 62 years (range, 19 to 86 years). Two patients underwent emergent surgery after endoscopic diagnosis. The other patients were allocated to four therapeutic endoscopic groups: group I, epinephrine injection (11 patients); group II, epinephrine injection plus heater probe coagulation (10 patients); group III, histoacryl injection (4 patients); and group IV, hemoclipping (2 patients). Initial treatment failure ocurred in three patients (all in group I) and they received surgery, hemoclipping, or band ligation as salvage therapy, respectively. Among those who achieved initial hemostasis, recurrent bleeding developed in two patients (all in group I) and was successfully controlled by endoscopic injection plus thermal therapy. No complication was noted after endoscopic treatment. Group II had a significantly higher successful hemostasis rate than group I (100 vs 54%; P = 0.02). One patient in the therapeutic endoscopy groups died during admission, for a mortality rate of 3.7%. Patients were followed up from 6 to 36 months and no further bleeding was noted. The results suggest that epinephrine injection plus heater probe coagulation was significantly superior to epinephrine injection alone in achieving hemostasis. Histoacryl injection, hemoclipping, and endoscopic band ligation were safe and effective alternate therapies.
Cheng
Chi-Liang
CL
Division of Gastroenterology/Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan. launaijn@gcn.net.tw
Liu
Nai-Jen
NJ
Lee
Ching-Song
CS
Chen
Pang-Chi
PC
Ho
Yu-Pin
YP
Tang
Jui-Hsiang
JH
Yang
Chun
C
Sung
Kai-Feng
KF
Lin
Cheng-Hui
CH
Chiu
Cheng-Tang
CT
D000208:Acute Disease; D000328:Adult; D000368:Aged; D004564:Electrocoagulation; D004659:Enbucrilate / Q000627:therapeutic use*; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D004659:Enbucrilate; D004837:Epinephrine