Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria.
Gastrointest Endosc. 2011 Sep;74(3):573-80. doi: 10.1016/j.gie.2011.05.027. Epub 2011 Jul 29.
Dieulafoy lesions consist of aberrant submucosal arteries, which can cause severe GI bleeding. The predominant location of Dieulafoy lesions is the upper GI tract.
To our best knowledge, this is the first systematic study on the frequency of bleeding from Dieulafoy lesions in the small bowel and the efficacy of enteroscopic therapy regarding primary hemostasis and long-term follow-up.
Multicenter, retrospective, observational study.
Nine Austrian centers doing double-balloon enteroscopy or single-balloon enteroscopy.
This study involved 284 consecutive patients who were referred for double-balloon enteroscopy or single-balloon enteroscopy because of suspicion of mid-GI bleeding.
A total of 317 double-balloon enteroscopy and 78 single-balloon enteroscopy procedures were performed in 284 patients with suspected mid-GI bleeding.
Demographic, clinical, procedural, and outcome data were collected.
A Dieulafoy lesion in the small bowel was identified as the source of mid-GI bleeding in 3.5% of patients, with a mean of 1.5 enteroscopy sessions required per diagnosis. In 9 cases the Dieulafoy lesion was found by enteroscopy from an oral approach, and in 1 patient the lesion was found by an anal approach. In all patients primary endoscopic hemostasis was successful. Eight of 10 patients were free from rebleeding episodes (median follow-up 14.5 months, interquartile range 10.0-17.5 months). In 2 of 10 patients, rebleeding occurred, and a surgical intervention was necessary.
Retrospective study.
Bleeding from Dieulafoy lesions of the small bowel seems to occur more frequently than previously estimated. Most of these lesions are located in the proximal jejunum and can be managed successfully by enteroscopy. After successful endoscopic hemostasis, rebleeding episodes occur in only 20% of patients.
Dieulafoy 病变由异常的黏膜下动脉引起，可导致严重的胃肠道出血。Dieulafoy 病变的主要部位在上胃肠道。
据我们所知，这是第一项关于小肠 Dieulafoy 病变出血频率以及内镜治疗在初次止血和长期随访方面的疗效的系统研究。
多中心、回顾性、观察性研究。
9 家奥地利中心进行双气囊内镜或单气囊内镜检查。
这项研究共纳入 284 例因怀疑中胃肠道出血而行双气囊内镜或单气囊内镜检查的连续患者。
对 284 例疑似中胃肠道出血的患者共进行了 317 例双气囊内镜和 78 例单气囊内镜检查。
收集人口统计学、临床、程序和结果数据。
3.5%的患者被诊断为小肠 Dieulafoy 病变是中胃肠道出血的原因，平均需要 1.5 次内镜检查才能确诊。9 例病变经口入路内镜检查发现，1 例病变经肛门入路发现。所有患者初次内镜止血均成功。10 例患者中有 8 例（中位随访 14.5 个月，四分位间距 10.0-17.5 个月）无再出血发作。10 例中有 2 例再出血，需要手术干预。
回顾性研究。
小肠 Dieulafoy 病变出血的发生率似乎高于先前估计。这些病变大多数位于空肠近端，可通过内镜成功治疗。初次内镜止血成功后，仅 20%的患者发生再出血。
