Katsinelos Panagiotis, Paroutoglou George, Mimidis Kostas, Beltsis Athanasios, Papaziogas Basilios, Gelas George, Kountouras Yiannis
Department of Endoscopy and Motility Unit, "G. Gennimatas" Hospital, Ethnikis Aminis 41, Thessaloniki 54635, Greece.
World J Gastroenterol. 2005 Oct 14;11(38):6022-6. doi: 10.3748/wjg.v11.i38.6022.
To investigate retrospectively the clinical and endoscopic features of bleeding Dieulafoy's lesions and to assess the short- and long-term effectiveness of endoscopic treatment.
Twenty-three patients who had gastrointestinal bleeding from Dieulafoy's lesions underwent endoscopic therapy. Demographic data, mode of presentation, risk factors for gastrointestinal bleeding, blood transfusion requirements, endoscopic findings, details of endoscopic therapy, recurrence of bleeding and mortality rates were collected and analyzed retrospectively.
Hemostasis was attempted by dextrose 50% plus epinephrine in 10 patients, hemoclipping in 8 patients, heater probe in 2 patients and ethanolamine oleate in 2 patients. Comorbid conditions were present in 17 patients (74%). Overall permanent hemostasis was achieved in 18 patients (78%). Initial hemostasis was successful with no recurrent bleeding in patients treated with hemoclipping, heater probe or ethanolamine injection. In the group of patients who received dextrose 50% plus epinephrine injection treatment, four (40%) had recurrent bleeding and one (10%) had unsuccessful initial hemostasis. Of the four patients who had rebleeding, three had unsuccessful hemostasis with similar treatment. Surgical treatment was required in five patients (22%) owing to uncontrolled bleeding, recurrent bleeding with unsuccessful retreatment and inability to approach the lesion. One patient (4.3%) died of sepsis after operation during hospitalization. There were no side-effects related to endoscopic therapy. None of the patients in whom permanent hemostasis was achieved presented with rebleeding from Dieulafoy's lesion over a mean long-term follow-up of 29.8 mo.
Bleeding from Dieulafoy's lesions can be managed successfully by endoscopic methods, which should be regarded as the first choice. Endoscopic hemoclipping therapy is recommended for bleeding Dieulafoy's lesions.
回顾性研究Dieulafoy病变出血的临床和内镜特征，并评估内镜治疗的短期和长期疗效。
23例Dieulafoy病变引起胃肠道出血的患者接受了内镜治疗。回顾性收集并分析患者的人口统计学数据、临床表现方式、胃肠道出血的危险因素、输血需求、内镜检查结果、内镜治疗细节、出血复发情况及死亡率。
10例患者尝试用50%葡萄糖加肾上腺素止血，8例患者用止血夹止血，2例患者用热探头止血，2例患者用油酸乙醇胺止血。17例患者（74%）存在合并症。18例患者（78%）实现了总体永久性止血。采用止血夹、热探头或乙醇胺注射治疗的患者初始止血成功，无复发出血。在接受50%葡萄糖加肾上腺素注射治疗的患者组中，4例（40%）出现复发出血，1例（10%）初始止血未成功。在4例再次出血的患者中，3例采用类似治疗止血未成功。5例患者（22%）因出血无法控制、再次出血且再次治疗未成功以及无法接近病变而需要手术治疗。1例患者（4.3%）在住院期间术后死于败血症。未发现与内镜治疗相关的副作用。在平均29.8个月的长期随访中，所有实现永久性止血的患者均未出现Dieulafoy病变再次出血。
Dieulafoy病变出血可通过内镜方法成功处理，应将其视为首选方法。对于Dieulafoy病变出血，推荐采用内镜止血夹治疗。
