Background and Study Aims: 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.
Patients and Methods: 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.
Results: 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.
Conclusions: 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.
References
-
1
Pointner R, Schwab G, Konisgsrainer A, Dietze O.
Endoscopic treatment of Dieulafoy’s disease.
Gastroenterology.
1988;
94
563-566
-
2
Lin H J, Lee F Y, Tsai Y T. et al .
Therapeutic endoscopy for Dieulafoy’s disease.
J Clin Gastroenterol.
1989;
11
507-510
-
3
Boron B, Mobarhan S.
Endoscopic treatment of Dieulafoy hemorrhage.
J Clin Gastroenterol.
1987;
9
518-520
-
4
Reilly H F 3rd, Al-Kawas F H.
Dieulafoy’s lesion: diagnosis and management.
Dig Dis Sci.
1991;
36
1702-1707
-
5
Chung I K, Kim E J, Lee M S. et al .
Bleeding Dieulafoy’s lesions and the choice of endoscopic method: comparing the hemostatic efficacy of mechanical and injection methods.
Gastrointestinal Endosc.
2000;
52
721-724
-
6
Park C H, Sohn Y H, Lee W S. et al .
The usefulness of endoscopic hemoclipping for bleeding Dieulafoy lesions.
Endoscopy.
2003;
35
388-392
-
7
Dy N M, Gostout C J, Balm R K.
Bleeding from the endoscopically-identified Dieulafoy’s lesion of the proximal small intestine and colon.
Am J Gastroenterol.
1995;
90
108-111
-
8
Stark M E, Gostout C J, Balm R K.
Clinical features and endoscopic management of Dieulafoy’s disease.
Gastrointest Endosc.
1992;
38
545-550
-
9
Nikolaidis N, Zenos P, Giouleme O. et al .
Endoscopic band ligation of Dieulafoy-like lesions in the upper gastrointestinal tract.
Endoscopy.
2001;
33
754-760
-
10
Abi-Hanna D, Williams S J, Gillespie P E, Bourke M J.
Endoscopic band ligation for non-variceal non-ulcer gastrointestinal hemorrhage.
Gastrointestinal Endosc.
1998;
48
510-514
-
11
McGrath K, Mergener K, Branch S.
Endoscopic band ligation of Dieulafoy’s lesion: report of two cases and review of the literature.
Am J Gastroenterol.
1999;
94
1087-1090
-
12
Banerjee B, Trivedi M H, Swied A M.
Endoscopic band ligation for gastric ulcer bleeding.
Surg Laparosc Endosc Percutan Tech.
2000;
10
246-248
-
13
Wong R, Ota S, Katoh A. et al .
Endoscopic ligation for non-esophageal variceal upper gastrointestinal hemorrhage.
Endoscopy.
1998;
30
774-777
-
14
Matsui S, Kamisako T, Kudo M, Inoue R.
Endoscopic band ligation for control of nonvariceal upper GI hemorrhage: comparison with bipolar electrocoagulation.
Gastrointest Endosc.
2002;
55
214-218
-
15
Mumtaz R, Shaukat M, Ramirez F C.
Outcomes of endoscopic treatment of gastroduodenal Dieulafoy’s lesion with rubber band ligation and thermal/injection therapy.
J Clin Gastroenterol.
2003;
36
310-314
-
16
Hachisu T.
Evaluation of endoscopic hemostasis using an improved clipping apparatus.
Surg Endosc.
1998;
2
13-17
-
17
Binmoeller K F, Thonke F, Soehendra N.
Endoscopic hemoclip treatment for gastrointestinal bleeding.
Endoscopy.
1993;
25
167-170
-
18
Chung I K, Ham J S, Kim H S. et al .
Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers.
Gastrointest Endosc.
1999;
49
13-18
-
19
Ohta S, Yukioka T, Ohta S. et al .
Hemostasis with endoscopic hemoclipping for severe gastrointestinal bleeding in critically ill patients.
Am J Gastroenterol.
1996;
91
701-704
-
20
Yamaguchi Y, Yamato T, Katsumi N. et al .
Endoscopic hemoclipping for upper GI bleeding due to Mallory-Weiss syndrome.
Gastrointest Endosc.
2001;
53
427-430
-
21
Scapa E.
Treating gastrointestinal bleeding with endoscopic hemoclips.
Surg Laparosc Endosc.
1997;
7
94-96
-
22
Kim J I, Kim S S, Park S. et al .
Endoscopic hemoclipping using a transparent cap in technically difficult cases.
Endoscopy.
2003;
35
659-662
J. S. Rew, M.D., Ph. D.
Division of Gastroenterology, Dept. of Internal Medicine
Chonnam National University Medical School · 8 Hak-dong, Dong-ku, Gwangju 501-757 · South Korea
Fax: + 82-62-228-1330 ·
eMail: p1052ccy@hanmail.net
