Mechanical Versus Injection Endoscopic Therapy for Dieulafoy's Lesion: a Systematic Review and Meta-Analysis.

Abstract

Background: Dieulafoy's lesion is a rare but potentially life-threatening gastrointestinal condition that often requires endoscopic management. However, there is a lack of consensus on the optimal endoscopic intervention for this condition. This meta-analysis aimed to compare the efficacy and safety of endoscopic mechanical interventions versus endoscopic injection interventions in the treatment of Dieulafoy's lesion.

Methods: A systematic literature search was conducted using PubMed, Google Scholar pages 0-20 and Cochrane Library databases to identify relevant studies published up to March 2023. Studies comparing the outcomes of endoscopic mechanical and injection interventions for Dieulafoy's lesion were included. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random or fixed effects model depending on the heterogeneity I 2 value. A total of seven comparative studies were included in the meta-analysis consisting of three clinical trials and four retrospective studies. The clinical outcomes consisted of the initial hemostasis, as well as adverse events: recurrent bleeding, death and the need for an operation.

Results: It was shown that endoscopic injection therapy was associated with a lower risk of recurrent bleeding in the treatment of Dieulafoy's lesion compared to mechanical therapy (95% CI, OR=0.33 [0.16, 0.69] , p-value=0.003). However, there were no significant differences between mechanical and injection techniques in terms of initial hemostasis, death, or need for an operation.

Conclusion: Our findings suggest that injection methods may be preferred over mechanical techniques in the management of Dieulafoy's lesion due to its potential to reduce recurrent bleeding. Although it is a simple and a non-expensive technique, further studies are needed to confirm these findings and evaluate the long-term outcomes of both interventions.