Risk Factors for Rebleeding after Emergency Endoscopic Treatment of Dieulafoy Lesion

Lai, Yongkang; Rong, Jianfang; Zhu, Zhenhua; Liao, Wenjian; Li, Bimin; Zhu, Yin; Chen, Youxiang; Shu, Xu

doi:10.1155/2020/2385214

Cited by 9 publications

(8 citation statements)

References 25 publications

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“…29 In previous studies, the rebleeding rates of DL after primary hemostasis have been reported as 8.6-19.5%. 30,31 In our study, the rebleeding rate in < 30 days among patients with DL was 25.42%, which was higher than that in previous reports. This may be because in this study, 81.0% of patients with DL with bleeding underwent endoscopic hemostasis using hemoclips.…”

Section: Discussioncontrasting

confidence: 69%

Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding

Noh

Cha

et al. 2023

J of Gastro and Hepatol

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Background and Aim Although Dieulafoy's lesion (DL) is an important cause of nonvariceal upper gastrointestinal (GI) bleeding, few studies have investigated the clinico‐epidemiological outcomes due to its rarity. Here, we investigated clinical features of upper GI bleeding caused by peptic ulcer (PU) or DL and compared endoscopic treatment outcomes. Methods Patients with upper GI bleeding resulting from PU or DL who visited emergency room between January 2013 and December 2017 were eligible. Clinical features and treatment outcomes were retrospectively investigated. Results Overall, 728 patients with upper GI bleeding due to PU (n = 669) and DL (n = 59) were enrolled. The median age was 64 years (interquartile range [IQR], 56–75 years), and 74.3% were male. Endoscopic intervention was performed in 53.7% (n = 359) and 98.3% (n = 58) of the PU and DL groups, respectively (P < 0.0001). Patients were matched by sex, age, body mass index, comorbidity, and past medical history, and 190 PU and 52 DL were finally selected. The rebleeding rates within 7 (7.37% vs 17.31%, P = 0.037) and 30 (7.37% vs 26.92%, P < 0.001) days after initial endoscopy were significantly lower in the PU than in the DL group after propensity score matching. During the median follow‐up period of 52 months (IQR, 34–70 months), there was no difference in overall survival rate (67.9% vs 82.7%, P = 0.518). Conclusions Although DL is a rare cause of upper GI bleeding, it requires endoscopic hemostasis more frequently and has a higher rate of rebleeding than PU even after therapeutic endoscopy. Endoscopists should pay attention and perform active endoscopic hemostasis for DL bleeding.

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Section: Discussioncontrasting

confidence: 69%

Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding

Noh

Cha

et al. 2023

J of Gastro and Hepatol

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“…4 Endoscopic injection, hemostatic clamping, ligation, and electrocoagulation are all common treatments, but there are still risks of hemostatic failure or bleeding recurrence. 5,6 Due to rapid bleeding and poor visual field, hemostasis under endoscopy failed in our case. Selective angiography can be used as a second-line treatment for DL.…”

Section: Discussionmentioning

confidence: 73%

“…Turk J Pediatr 2022; 64 (6): [1151][1152][1153][1154][1155] The Turkish Journal of Pediatrics ▪ November-December 2022 Turk J Pediatr 2022; 64 (6): [1151][1152][1153][1154][1155] The Turkish Journal of Pediatrics ▪ November-December 2022…”

Section: Ethical Approvalmentioning

confidence: 99%

Duodenal Dieulafoy lesion: a rare pathogeny of gastrointestinal bleeding in children

Liu¹,

Zhang²,

Li³

2022

Turk J Pediatr

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Background. Dieulafoy lesion is a calibre persistent submucosal artery associated with a minuter mucosal defect. Dieulafoy lesion has been reported to account for 1-5.8% of acute nonvariceal upper gastrointestinal bleeding in adults, but it is rarely reported in children. Case. Here we report a case of duodenal Dieulafoy lesion in a 13-year-old boy. After endoscopy and laparotomy, he still had no definite diagnosis and effective treatment. The duodenal Dieulafoy lesion was finally identified by selective angiography and was effectively treated by intravascular embolization. Conclusions. For unexplained upper gastrointestinal bleeding, the possibility of duodenal Dieulafoy lesion should be considered. A combination of multiple diagnosis and treatment methods can improve the success rate of diagnosis and treatment when a single test or treatment method cannot provide definitive diagnosis or effective treatment.

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“…With the advancement of endoscopic techniques, many gastrointestinal lesions have been properly managed, but there are still challenges. Most upper non-variceal gastrointestinal bleeding (UNVGIB) could be treated by conventional endoscopic therapies, but recent studies have shown that some UNVGIB such as Dieulafoy's lesion and refractory bleeding could not be treated successfully and develop recurrence easily after standard endoscopic therapies such as epinephrine injections, hemoclips, or coagulation ( 1 , 2 ). Equally, although many treatments have been attempted for the closure of perforations and fistulas, more and more iatrogenic gastric perforations are raised during endoscopic resection such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), which could be handled by endoscopic closure and conservative management.…”

Section: Introductionmentioning

confidence: 99%

Over-the-Scope Clip Applications as First-Line Therapy in the Treatment of Upper Non-variceal Gastrointestinal Bleeding, Perforations, and Fistulas

Qiu

Zhang

et al. 2022

Front. Med.

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BackgroundThe over-the-scope clip (OTSC) is an innovative device and has been successfully used in endoscopic treatment, however, there is a lack of clinical data from China. The aim of this study is to investigate the OTSC applications in the treatment of upper non-variceal gastrointestinal bleeding (UNVGIB), perforations, and fistulas in China.MethodsIn total, 80 patients were treated with one OTSC respectively as first-line therapy in our endoscopy center between January 2016 and November 2020. Among them, 41 patients had UNVGIB, 34 patients had perforations, and five patients had fistulas. The technical and clinical success rates were used to assess the efficacy of OTSC on the above diseases. In addition, we compared the hemostatic efficacy of OTSC with the standard endoscopic therapy in ulcer bleeding and Dieulafoy's lesion by propensity score matching analysis.ResultsIn general, the OTSCs were applied successfully in all patients and achieved 100% (80/80) technical success. The clinical success of all patients was 91.3% (73/80). Among 41 patients with UNVGIB, the clinical success was 85.4% (35/41); 6 patients presented with recurrence. For patients of Dieulafoy's lesion and under antithrombotic therapy, we found that OTSC treatment had both efficient and reliable hemostasis effects. In addition, according to the characteristics of ulcers, site of bleeding lesion, and Blatchford score, all patients received similar and reliable clinical success rates. After propensity score matching, we found that OTSC treatment had low rebleeding rates when compared with standard endoscopic therapy in both Dieulafoy's lesion (15.0 vs 30.0%) and ulcer bleeding (17.6 vs 29.4%). Among 34 patients with perforations, the clinical success was 100% (34/34). Among five patients with fistulas, only one patient failed in maintaining the OTSC before esophageal fistula healing, and the clip achieved an overall clinical success of 80% (4/5).ConclusionThe OTSC represents a safe and effective endoscopic therapy for UNVGIB, perforations, and fistulas as first-line treatment, especially for Dieulafoy's lesion or patients under antithrombotic therapy for UNVGIB, etc. However, OTSC application in these specific lesions or patients lacks adequate evidence as first-line treatment. Therefore, further larger sample and multi-center clinical trials are required to improve its indications in clinical treatment.

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Risk Factors for Rebleeding after Emergency Endoscopic Treatment of Dieulafoy Lesion

Cited by 9 publications

References 25 publications

Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding

Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding

Duodenal Dieulafoy lesion: a rare pathogeny of gastrointestinal bleeding in children

Over-the-Scope Clip Applications as First-Line Therapy in the Treatment of Upper Non-variceal Gastrointestinal Bleeding, Perforations, and Fistulas

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