A Prospective, Randomized Trial of Endoscopic Band Ligation Versus Endoscopic Hemoclip Placement for Bleeding Gastric Dieulafoy’s Lesions

 

 Buy Article Permissions and Reprints

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
  PubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 3 Boron B, Mobarhan S. Endoscopic treatment of Dieulafoy hemorrhage.  J Clin Gastroenterol. 1987;  9 518-520
  PubMedGoogle Scholar
• 4 Reilly H F 3rd, Al-Kawas F H. Dieulafoy’s lesion: diagnosis and management.  Dig Dis Sci. 1991;  36 1702-1707
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  Article in Thieme ConnectPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  Article in Thieme ConnectPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 13 Wong R, Ota S, Katoh A. et al . Endoscopic ligation for non-esophageal variceal upper gastrointestinal hemorrhage.  Endoscopy. 1998;  30 774-777
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 16 Hachisu T. Evaluation of endoscopic hemostasis using an improved clipping apparatus.  Surg Endosc. 1998;  2 13-17
  PubMedGoogle Scholar
• 17 Binmoeller K F, Thonke F, Soehendra N. Endoscopic hemoclip treatment for gastrointestinal bleeding.  Endoscopy. 1993;  25 167-170
  Article in Thieme ConnectPubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 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
  CrossrefPubMedGoogle Scholar
• 21 Scapa E. Treating gastrointestinal bleeding with endoscopic hemoclips.  Surg Laparosc Endosc. 1997;  7 94-96
  CrossrefPubMedGoogle Scholar
• 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
  Article in Thieme ConnectPubMedGoogle Scholar

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