出血性 Dieulafoy 病变的临床、内窥镜和治疗特点:病例系列和文献综述。

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Basma Aabdi, Ghizlane Kharrasse, Abdelkrim Zazour, Hajar Koulali, Ouiam Elmqaddem, Ismaili Zahi
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引用次数: 0

摘要

目的:Dieulafoy病变(DLs)是一种罕见但可能危及生命的胃肠道(GI)出血源。在此,我们回顾性地描述了DLs的临床和内镜特征,回顾了内镜治疗DLs出血的短期和长期效果,并确定了我们内镜室的复发率和死亡率以及风险因素:数据收集自2018年1月至2023年8月期间继发于DLs的消化道出血患者。对患者的病历以及内镜数据库进行回顾性审查。结果:在 1170 例消化道出血病例中,我们只发现了 7 例涉及 DL 的病例。中位年龄为 74 岁,男女比例为 2.5。75%的患者有严重的合并症,主要是心血管疾病。只有抗凝剂和抗血小板药物与DLs有显著相关性。所有患者的最初症状都是消化道出血。85%的病例通过最初的内镜检查确诊。所有接受内镜治疗的患者都获得了初步止血。然而,研究发现,在仅接受肾上腺素注射或氩等离子体凝固治疗的三名患者中,有两名患者早期复发。相比之下,接受联合治疗的三名患者中有一名出现了晚期复发(平均随访时间为 1 年)。有一例患者需要进行病理诊断。一名患者(14%)死于失血性休克。平均住院时间为 3 天:DL虽然罕见,但可能是活动性、复发性和不明原因消化道出血的原因。由于内镜疗法的出现,复发率有所下降,预后也大为改善。因此,内镜方法仍是治疗出血性 DL 的首选。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical, endoscopic and therapeutic features of bleeding Dieulafoy's lesions: case series and literature review.

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.

Design: 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.

Conclusion: 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.

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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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