title: Hemostatic efficacy and clinical outcome of endoscopic treatment of Dieulafoy's lesions: comparison of endoscopic hemoclip placement and endoscopic band ligation.
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).
  
  
  METHODS
  Retrospective, single-center study.
  
  
  METHODS
  A tertiary-care referral university hospital.
  
  
  METHODS
  Sixty-six patients who received mechanical endoscopic hemostasis for bleeding DLs.
  
  
  METHODS
  Endoscopic hemostasis.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Dong-Won
authors.initials: DW
authors.lastname: Ahn
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Cheol Min
authors.initials: CM
authors.lastname: Shin
authors.forename: Jin-Hyeok
authors.initials: JH
authors.lastname: Hwang
authors.forename: Jin-Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Sook-Hyang
authors.initials: SH
authors.lastname: Jeong
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D004386:Duodenum / Q000098:blood supply*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000628:therapy*