Efficacy of endoscopic clipping and long-term follow-up of bleeding Dieulafoy's lesions in the upper gastrointestinal tract.

BACKGROUND/AIMS: Dieulafoy's lesion is a rare cause of upper gastrointestinal hemorrhage. The aim of this prospective study was to assess the efficacy and safety of endoscopic clipping for upper gastrointestinal bleeding due to Dieulafoy's lesion.

METHODOLOGY

From January 1998 to March 2001, 21 patients (9 women and 12 men; mean age 66 +/- 16 yrs) with bleeding Dieulafoy's lesion have been admitted. Endoscopic clipping was performed in all patients using a clipping device consisting of a clip applicator device and stainless steel hemoclips (Olympus, Japan). A follow-up endoscopy was performed within the following 24-48 hours to confirm the success of hemostasis. Hemostatic rate, rebleeding rate, amount of blood transfusion, and duration of hospital stay were analyzed.

RESULTS

The initial hemoclip therapy was successful in 20 out of 21 (95.2%) patients. Two patients had recurrent bleeding. One patient in whom recurrent bleeding occurred died. The successful surgical treatment was done in one patient in whom initial hemoclip therapy was unsuccessful. Therefore, the overall hemostasis was observed in 19 out of 21 patients (90.5%). There were no complications related to endoscopic therapy.

CONCLUSIONS

Endoscopic hemoclipping provided a very effective and safe modality for hemostasis in patients with bleeding Dieulafoy's lesions.