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01.10.2016 | original article | Ausgabe 19-20/2016

Wiener klinische Wochenschrift 19-20/2016

The efficiency of endoclips in maintaining the gastrointestinal bleeding-related Dieulafoy’s lesion

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 19-20/2016
Autoren:
MD Fatih Karaahmet, MD Serta Kılıncalp, MD Yusuf Coskun, MD Mevlut Hamamci, MD Hakan Akinci, MD Yusuf Ustun, MD Zahide Simsek, MD Elife Erarslan, MD Sahin Coban, MD Ilhami Yuksel

Summary

Background

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.

Aims

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.

Patients and methods

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.

Results

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.

Conclusions

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.

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