Clinical Features, Endoscopic Management and Outcome of Patients with Non-variceal Upper Digestive Bleeding by Dieulafoy Lesion

Abstract

Abstract:Aim and background: Dieulafoy lesion (DL) represents a rare, but important cause of major upper digestive bleeding, especially in elders. The aim of the study consists in identifying the clinico-biological and endoscopic features and the outcome of these patients. Methods:We retrospectively evaluated the patients admitted with non-variceal upper digestive bleeding (UDB) in the Department of Gastroenterology, of the Emergency County Hospital Timisoara, from 2003 to 2014. Out of the total number of cases we selected the patients with endoscopic diagnosis of Dieulafoy lesion. In these patients we analyzed the demographic, clinico-biological and endoscopic data, compared to the control group that encountered the rest of the patients with UDB. Results:Out of 2104 patients with non-variceal UDB, 31/2104 (1.5%) presented DL, 19/31(61.3%) male and 12/31(38.7%) female, mean age 63 ± 12.83. Diabetes mellitus was present in 35.5% cases. The mean value of hemoglobin was significantly lower in Dieulafoy group 7 ± 2.69 vs. 8 ± 3.28 in the control group, p=0.05, thus a significantly larger number of blood units per patient were needed in this group (p<0.0001). Re-bleebing was encountered significantly more often in Dieulafoy vs. control group: 7/31(22.6%) vs. 173/2074 (8.34%), p=0.03; surgery was needed in 3/31(9.7%) Dieulafoy patients. Endoscopic haemostasis was achieved most frequently by using combined treatment. The use of anticoagulants had a significant influence in the development of DL (p=0.019).Conclusion: DL may cause massive bleeding and is associated with a high rate of re-bleeding. Patients present comorbidities, diabetes mellitus being mostly associated with this condition. Anticoagulants represent risk factors highly associated with DL.

Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

“…This finding was in agreement with Jiménez et al, 12 who found that low systolic blood pressure, high creatinine, and albumin levels were independent factors associated with rebleeding. In our study increased Child, MELD, AIMS56, and Sofa scores were risk factors for early rebleeding, as was stated by Goldis et al 13…”

“…We have detected significant differences between the studied patients as regards associations (hepatic encephalopathy, spontaneous bacterial peritonitis, thrombocytopenia, increase serum creatinine, raised INR, and prolonged prothrombin time), as did Goldis et al 13…”

The Essential Role of Esophagogastroduodenoscopy Prior to bariatric surgery

“…This does not illustrate the reason for the huge gastric remnant seen at the laparoscopy because it was at least 200 cm far from the pouch and backwards low of blood is very unlikely. Our opinion is, due to 90% diagnostic rate and about 75-100% success in hemostasis, on-table EGD should have a more highlighted role in treatment of the reported case [3].…”