Clinical characteristics of Dieulafoy’s Lesion in the Small Bowel Diagnosed and Treated by Double-Balloon Endoscopy

Abstract

BACKGROUNDS Obscure gastrointestinal bleeding indicates bleeding in which the source cannot be determined even by balloon-assisted endoscopy. In some cases, the cause is assumed to be a Dieulafoy’s lesion in the small bowel. AIM This retrospective study aimed to reveal the clinical characteristics of Dieulafoy’s lesion in the small bowel as diagnosed by double-balloon endoscopy and consider whether it is possible to predict bleeding from Dieulafoy’s lesionbefore endoscopy in obscure gastrointestinal bleeding. METHOD We reviewed the database of our hospital and identified 38 patients who were diagnosed with Dieulafoy’s lesion and underwent treatment during double-balloon endoscopy. The clinical background, diagnosis, and treatment details of patients with Dieulafoy’s lesion were examined. RESULTS The median age of the 38 patients was 72 years, and 50% of the patients were male. Of the patients, 26 (68%) had a high comorbidity index. We analyzed whether the first double-balloon endoscopy could be definitely diagnosed. Multivariate analysis revealed that hematochezia of ≥ 2 episodes was the independent factor associated with ≥ 2 double-balloon endoscopy diagnoses. The factors associated with re-bleeding after endoscopic treatment were analyzed. Multivariate analysis did not reveal any independent factor associated with re-bleeding, although the number of hemoclips used was likely to be associated. CONCLUSION In cases where a patient experiences two or more episodes of hematochezia, balloon-assisted endoscopy, prepared with optional devices, should be scheduled at the earliest possible time.

Unveiling Dieulafoy’s Lesion: A Case Report on Upper Gastrointestinal Bleeding Caused by Dieulafoy’s Lesion

“…Excessive blood in the stomach can also make it difficult to locate the bleeding site. As a result, multiple endoscopies may be needed before a diagnosis can be made [6,7]. Biopsies of the affected vessel usually avoid due to the risk of bleeding.…”