Endoscopic Treatment of Dieulafoy Lesions and Risk Factors for Rebleeding

Abstract

Background/AimsDieulafoy 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.MethodsRecords 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.ResultsPrimary 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.ConclusionsEndoscopic 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.

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

“…Although most of the researches have shown that Dieulafoy lesions are an uncommon cause of GI bleeding, the results of Lim and colab found them to be a relatively frequent etiology, accounting for 14.1% of nonvariceal upper gastrointestinal bleeding [20].…”

“…The use of non-steroidal anti-inflammatory drugs (NSAIDs) or anticoagulants and the presence of active stages of the Forrest classification at endoscopy have been significantly associated with the risk of re-bleeding [20]. Jamanca-Poma et al reported that, despite the high rate of comorbidities, no significant relationship was found between comorbidity and re-bleeding risk in Dieulafoy patients [40].…”

“…Often, diagnosis may be difficult especially during the initial episode of hemorrhage due both to the small size of the lesion and the intermittent nature of the bleeding therefore a lot of patients require multiple endoscopic examinations for accurate diagnosis [6,17]. The condition was initially treated surgically [18]; with the advance of endoscopic techniques, nowadays therapeutic endoscopy is the treatment of choice, the hemostasis success rates achieving 75-100% [17,[19][20][21][22][23][24].…”

Endobronchial Argon Plasma Coagulation for Treatment of Dieulafoy Disease

“…Any part of the gastrointestinal system can be affected. 6 Dieulafoy disease of the bronchus is a rare disease. Very few cases have been reported in English medical literature.…”

“…To the best of our knowledge, no case treated by an endobronchial approach, including the gastrointestinal tract, has been reported. 6 Argon plasma coagulation has a lower penetration depth and is selectively oriented to the bleeding area; it is a frequently used method for visible hemorrhagic lesions of the tracheobronchial tree. Although the use of argon plasma coagulation is generally safe, a major complication can be air emboli.…”