目的:Dieulafoy病变(DL)是一种罕见但可能危及生命的胃肠道(GI)出血来源。它们约占所有急性非静脉曲张性消化道出血病例的1%-6.5%。这里,我们回顾性描述了临床和内镜特征,回顾内镜下出血DLs治疗的短期和长期结果,我们确定发生率和危险因素,我们内镜单元的复发和死亡率。
方法:数据收集自2018年1月至2023年8月期间继发于DL的消化道出血患者。对患者的医疗记录和内镜数据库进行回顾性审查。人口统计数据,危险因素,出血部位,内窥镜技术的结果,考虑了复发率和死亡率.
结果:1170例消化道出血,我们仅确定了7例涉及DL的病例。中位年龄是74岁,男女比例为2.5。75%的患者有明显的合并症,主要是心血管疾病。只有抗凝剂和抗血小板药物与DL显著相关。所有患者均以消化道出血为首发症状。最初的内窥镜检查导致85%的病例得到诊断。所有经内镜治疗的患者均获得了初始止血。然而,该研究显示,仅接受肾上腺素注射或氩离子凝固治疗的3例患者中有2例出现早期复发。相比之下,接受联合治疗的三名患者之一,经历了晚期复发(平均随访1年)。1例需要病理诊断。1例患者(14%)死于失血性休克。平均住院时间为3天。
结论:虽然罕见,DL可能是活跃的,复发性和不明原因的消化道出血。由于内窥镜治疗的出现,复发率降低,预后明显改善。因此,内镜方法仍然是治疗出血DLs的首选方法.
OBJECTIVE: Dieulafoy\'s lesions (DLs) are a rare but potentially life-threatening source of gastrointestinal (GI) haemorrhage. They are responsible for roughly 1%-6.5% of all cases of acute non-variceal GI bleeding.Here, we describe retrospectively the clinical and endoscopic features,
review the short-term and long-term outcomes of endoscopic management of bleeding DLs and we identify rate and risk factors, of recurrence and mortality in our endoscopic unit.
METHODS: Data were collected from patients presenting with GI haemorrhagic secondary to DLs between January 2018 and August 2023. Patients\' medical records as well as endoscopic databases were retrospectively reviewed. Demographic data, risk factors, bleeding site, outcomes of endoscopy techniques, recurrence and mortality rate were taken into account.
RESULTS: Among 1170 cases of GI bleeding, we identified only seven cases involving DLs. Median age was 74 years, with a male-to-female ratio of 2.5. 75% of patients had significant comorbidities, mainly cardiovascular diseases. Only anticoagulant and antiplatelet agents were significantly associated with DLs. All patients were presented with GI bleeding as their initial symptom. The initial endoscopy led to a diagnosis in 85% of the cases. Initial haemostasis was obtained in all patients treated endoscopically. Nevertheless, the study revealed early recurrence in two out of three patients treated solely with epinephrine injection or argon plasma coagulation. In contrast, one of three patients who received combined therapy, experienced late recurrence (average follow-up of 1 year). Pathological diagnosis was necessary in one case. One patient (14%) died of haemorrhagic shock. Average length of hospital stay was 3 days.
CONCLUSIONS: Although rare, DLs may be responsible for active, recurrent and unexplained GI bleeding. Thanks to the emergence of endoscopic therapies, the recurrence rate has decreased and the prognosis has highly improved. Therefore, the endoscopic approach remains the first choice to manage bleeding DLs.