Abstract：
BACKGROUND: Dieulafoy\'s lesion (DL) is a rare and important cause of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), however, there is a lack of clear guidelines focus on the endoscopic hemostasis treatment for DL. Sclerotherapy, as the ANVUGIB guideline recommended endoscopic hemostasis method, is widely used in clinical practice. The aim of this study is to investigate the efficacy of sclerotherapy as the initial treatment for Dieulafoy\'s lesion of the upper gastrointestinal tract (UDL).
METHODS: Patients with UDL who underwent the ANVUGIB standard endoscopic hemostasis between April 2007 and January 2023 were enrolled. The endoscopic therapy method was left to the discretion of the endoscopist.
RESULTS: In total, 219 patients were finally obtained, with 74 (33.8%) receiving sclerotherapy and 145 (66.2%) receiving other standard endoscopic therapy. The rebleeding within 30 days was significantly lower in the sclerotherapy group compared to the other standard group (5.8% vs. 16.8%, p = 0.047). There were no significant differences between the two groups in terms of successful hemostasis rate (93.2% vs. 94.5%, p = 0.713), median number of red blood cell transfusions (3.5 vs. 4.0 units, p = 0.257), median hospital stay (8.0 vs. 8.0 days, p = 0.103), transferred to ICU rate (8.1% vs. 6.2%, p = 0.598), the need for embolization or surgery rate (12.2% vs. 9.7%, p = 0.567) and 30-day mortality (0 vs. 2.1%, p = 0.553). In addition, we found no difference in efficacy between sclerotherapy alone and combination (3.1% vs. 8.1%, p = 0.714). Further analysis revealed that thermocoagulation for hemostasis was associated with a higher rate of rebleeding (28.6% vs. 3.1%, p = 0.042) and longer hospital stay (11.5 vs. 7.5 days, p = 0.005) compared to sclerotherapy alone.
CONCLUSIONS: Sclerotherapy represents an effective endoscopic therapy for both alone and combined use in patients with upper gastrointestinal Dieulafoy\'s lesion. Therefore, sclerotherapy could be considered as initial treatment in patients with bleeding of UDL.
METHODS: Patients with UDL who underwent the ANVUGIB standard endoscopic hemostasis between April 2007 and January 2023 were enrolled. The endoscopic therapy method was left to the discretion of the endoscopist.
RESULTS: In total, 219 patients were finally obtained, with 74 (33.8%) receiving sclerotherapy and 145 (66.2%) receiving other standard endoscopic therapy. The rebleeding within 30 days was significantly lower in the sclerotherapy group compared to the other standard group (5.8% vs. 16.8%, p = 0.047). There were no significant differences between the two groups in terms of successful hemostasis rate (93.2% vs. 94.5%, p = 0.713), median number of red blood cell transfusions (3.5 vs. 4.0 units, p = 0.257), median hospital stay (8.0 vs. 8.0 days, p = 0.103), transferred to ICU rate (8.1% vs. 6.2%, p = 0.598), the need for embolization or surgery rate (12.2% vs. 9.7%, p = 0.567) and 30-day mortality (0 vs. 2.1%, p = 0.553). In addition, we found no difference in efficacy between sclerotherapy alone and combination (3.1% vs. 8.1%, p = 0.714). Further analysis revealed that thermocoagulation for hemostasis was associated with a higher rate of rebleeding (28.6% vs. 3.1%, p = 0.042) and longer hospital stay (11.5 vs. 7.5 days, p = 0.005) compared to sclerotherapy alone.
CONCLUSIONS: Sclerotherapy represents an effective endoscopic therapy for both alone and combined use in patients with upper gastrointestinal Dieulafoy\'s lesion. Therefore, sclerotherapy could be considered as initial treatment in patients with bleeding of UDL.
摘要：
背景：Dieulafoy病变（DL）是急性非静脉曲张性上消化道出血（ANVUGIB）的罕见且重要的原因，然而,对于DL的内镜止血治疗缺乏明确的指南.硬化疗法,作为ANVUGIB指南推荐的内镜止血方法，广泛应用于临床。这项研究的目的是研究硬化疗法作为Dieulafoy上消化道（UDL）病变的初始治疗的疗效。
方法：纳入2007年4月至2023年1月接受ANVUGIB标准内镜止血的UDL患者。内窥镜治疗方法由内窥镜医师自行决定。
结果：总计，最终获得219名患者，74（33.8％）接受硬化治疗，145（66.2％）接受其他标准内窥镜治疗。与其他标准组相比，硬化治疗组30天内的再出血明显减少（5.8％vs.16.8%,p=0.047)。两组在成功止血率方面没有显着差异（93.2％vs.94.5%,p=0.713),红细胞输血的中位数（3.5vs.4.0单位,p=0.257)，中位住院时间（8.0vs.8.0天,p=0.103)，转入ICU率（8.1%vs.6.2%,p=0.598),需要栓塞或手术率(12.2%vs.9.7%,p=0.567）和30天死亡率（0vs.2.1%,p=0.553)。此外,我们发现单独硬化疗法和联合硬化疗法的疗效没有差异(3.1%vs.8.1%,p=0.714）。进一步分析显示，热凝止血与更高的再出血率相关（28.6%vs.3.1%,p=0.042）和更长的住院时间（11.5vs.7.5天,p=0.005）与单独的硬化疗法相比。
结论：硬化剂治疗是上消化道Dieulafoy病变患者单独使用和联合使用的有效内镜治疗方法。因此,硬化治疗可作为UDL出血患者的初始治疗。
方法：纳入2007年4月至2023年1月接受ANVUGIB标准内镜止血的UDL患者。内窥镜治疗方法由内窥镜医师自行决定。
结果：总计，最终获得219名患者，74（33.8％）接受硬化治疗，145（66.2％）接受其他标准内窥镜治疗。与其他标准组相比，硬化治疗组30天内的再出血明显减少（5.8％vs.16.8%,p=0.047)。两组在成功止血率方面没有显着差异（93.2％vs.94.5%,p=0.713),红细胞输血的中位数（3.5vs.4.0单位,p=0.257)，中位住院时间（8.0vs.8.0天,p=0.103)，转入ICU率（8.1%vs.6.2%,p=0.598),需要栓塞或手术率(12.2%vs.9.7%,p=0.567）和30天死亡率（0vs.2.1%,p=0.553)。此外,我们发现单独硬化疗法和联合硬化疗法的疗效没有差异(3.1%vs.8.1%,p=0.714）。进一步分析显示，热凝止血与更高的再出血率相关（28.6%vs.3.1%,p=0.042）和更长的住院时间（11.5vs.7.5天,p=0.005）与单独的硬化疗法相比。
结论：硬化剂治疗是上消化道Dieulafoy病变患者单独使用和联合使用的有效内镜治疗方法。因此,硬化治疗可作为UDL出血患者的初始治疗。
