Karaahmet Fatih, Kılıncalp Serta, Coskun Yusuf, Hamamci Mevlut, Akinci Hakan, Ustun Yusuf, Simsek Zahide, Erarslan Elife, Coban Sahin, Yuksel Ilhami
Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey.
Department of Gastroenterology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey.
Wien Klin Wochenschr. 2016 Oct;128(19-20):700-705. doi: 10.1007/s00508-015-0739-1. Epub 2015 Apr 9.
Dieulafoy's lesion (DL) is a relatively uncommon medical condition characterized by a large tortuous arteriole in the submucosa of any part of gastrointestinal (GI) tract wall that bleeds via erosion likely caused in the submucosal surface by protrusion of the pulsatile arteriole. Compared with other endoscopic hemostatic techniques, clipping alone for DL is limited.
The aim of the present case series study is to identify common clinical and endoscopic features, rates of occurrence, to review the outcome of endoscopic management of upper GI tract DL, and to illustrate the use and the efficiency of endoclips in maintaining the GI bleeding due to DL.
This case series was conducted at Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital. The patients who were admitted to the emergency department of Dıskapı Yıldırım Beyazıt Educational and Research Hospital underwent gastrointestinal system (GIS) endoscopy between 2008 and 2013 and were assessed retrospectively. Five cases of GI bleeding related to DL were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated.
The median number of endoscopic hemoclips application in first endoscopy was 4 (2-9). Rebleeding developed in all patients who had hemoclips applied. Re-endoscopy was performed in three of these patients, which controlled the bleeding. Two patients were transferred to surgery.
Combination of endoscopic injection and mechanical therapies seems a suitable method for maintaining upper GIS bleeding due to DL. Also, further studies are needed to better define the best endoscopic approach for the treatment of DL.
Dieulafoy病（DL）是一种相对罕见的病症，其特征是胃肠道（GI）壁任何部位的黏膜下层有一条粗大迂曲的小动脉，通过搏动性小动脉突出导致黏膜下表面糜烂而出血。与其他内镜止血技术相比，单纯使用夹子治疗DL有局限性。
本病例系列研究的目的是确定常见的临床和内镜特征、发生率，回顾上消化道DL的内镜治疗结果，并说明内镜夹在维持因DL导致的GI出血方面的应用和效果。
本病例系列在迪斯科皮·耶尔德勒姆·贝亚齐特教育与研究医院胃肠病科进行。2008年至2013年期间，入住迪斯科皮·耶尔德勒姆·贝亚齐特教育与研究医院急诊科的患者接受了胃肠系统（GIS）内镜检查，并进行回顾性评估。5例与DL相关的GI出血患者接受了内镜下止血夹应用治疗。评估临床资料、内镜检查结果及治疗效果。
首次内镜检查时内镜止血夹应用的中位数为4（2 - 9）。所有应用止血夹的患者均出现再出血。其中3例患者进行了再次内镜检查，出血得到控制。2例患者转至外科手术。
内镜注射和机械治疗相结合似乎是维持因DL导致的上消化道GIS出血的合适方法。此外，还需要进一步研究以更好地确定治疗DL的最佳内镜方法。
