Park C H, Joo Y E, Kim H S, Choi S K, Rew J S, Kim S J
Division of Gastroenterology, Dept. of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Endoscopy. 2004 Aug;36(8):677-81. doi: 10.1055/s-2004-825661.
Dieulafoy's lesion is a rare cause of massive gastrointestinal hemorrhage, most commonly in the proximal stomach. Mechanical endoscopic methods have recently become the standard therapeutic approach. However, there have been few studies comparing the efficacy of different mechanical endoscopic methods in treating gastric Dieulafoy's lesions. This study was therefore carried out to compare the hemostatic efficacy and safety of endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP) in the treatment of bleeding gastric Dieulafoy's lesions.
Between January 2002 and October 2003, 26 consecutive patients with bleeding gastric Dieulafoy's lesions were prospectively enrolled and were randomly assigned to undergo EBL (13 patients) or EHP (13 patients). Demographic characteristics, endoscopic variables, and outcome parameters, including rates of hemostasis and recurrent bleeding, were analyzed.
One O-ring was applied in each case in the EBL group, and the median number of hemoclips applied was one (range one to four) in the EHP group. There were no significant differences between the groups with regard to age, sex, presence of shock, initial hemoglobin level, coagulopathy, concurrent diseases, location of the lesion, type of bleeding stigmata, blood transfusion requirements, or hospitalization periods. Primary hemostasis was achieved in all 26 patients. There was one case of recurrent bleeding in each group; secondary hemostasis was achieved with EBL in one of these patients and by endoscopic epinephrine injection in the other. There were no second episodes of recurrent bleeding, no procedure-related complications, no cases in which surgery was needed, and no bleeding-related deaths in either group.
In this small study, no differences were detected in the efficacy or the safety of EBL vs. EHP in the management of bleeding gastric Dieulafoy's lesions.
Dieulafoy病是导致大量胃肠道出血的罕见病因，最常见于胃近端。机械内镜治疗方法近来已成为标准治疗手段。然而，比较不同机械内镜治疗方法对胃Dieulafoy病疗效的研究甚少。因此，本研究旨在比较内镜下套扎术（EBL）与内镜下止血夹置放术（EHP）治疗出血性胃Dieulafoy病的止血效果及安全性。
2002年1月至2003年10月，前瞻性纳入26例连续性出血性胃Dieulafoy病患者，并随机分为EBL组（13例）和EHP组（13例）。分析人口统计学特征、内镜变量及包括止血率和再出血率在内的结局参数。
EBL组每例患者应用1个O形圈套，EHP组应用止血夹的中位数为1个（范围1至4个）。两组在年龄、性别、休克状态、初始血红蛋白水平、凝血功能障碍、并存疾病、病变部位、出血征象类型、输血需求或住院时间方面无显著差异。26例患者均实现了初次止血。每组各有1例再出血病例；其中1例经EBL实现二次止血，另1例经内镜肾上腺素注射实现二次止血。两组均无再次再出血情况、无手术相关并发症、无需手术治疗的病例以及与出血相关的死亡病例。
在这项小型研究中，EBL与EHP治疗出血性胃Dieulafoy病的疗效和安全性未发现差异。
