Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy's lesion

作     者：Yuliana Jamanca-Poma Antonio Velasco-Guardado Concepción Piero-Pérez Renzo Calderón-Begazo Josue Umaa-Mejía Fernando Geijo-Martínez Antonio Rodríguez-Pérez 

作者机构：Department of Digestive SystemUniversity Hospital of Salamanca 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2012年第18卷第40期

页      面：5734-5738页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：肠道出血 复发率 胃肠道 病变 预后 联合治疗 危险因素 发育不良 

摘      要：AIM:To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent ***:Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy s lesion(DL) from 2005 to *** analyzed the demographic characteristics of the patients,risk factors for gastrointestinal bleeding,endoscopic findings,characteristics of the endoscopic treatment,and the recurrence of *** included cases in which endoscopy described a lesion compatible with *** excluded patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic ***:Twenty-nine patients with DL were *** of them were men with an average age of 71.5 ***-five percent of the patients received antiaggregatory or anticoagulant *** most common location for DL was the stomach(51.7%).The main type of bleeding was oozing in 65.5% of *** 27.6% of cases,there was arterial(spurting) bleeding,and 6.9% of the patients presented with an adherent clot.A single endoscopic treatment was applied to nine patients(31%);eight of them with adrenaline and one with argon,while 69% of the patients received combined *** patients(20.7%) presented with recurrent bleeding at a median of 4 d after endoscopy(interquartile range = 97.75).Within these six patients,the new endoscopic treatment obtained a therapeutic success of 100%.The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding(50% vs 33.3% for other type of bleeding) [P = 0.024,odds ratio(OR) = 8.5,95% CI = 1.13-63.87].The use of combined endoscopic treatment prevented the recurrence of bleeding(10% vs 44.4% of single treatment)(P = 0.034,OR = 0.14,95% CI = 0.19-0.99).CONCLUSION:Endoscopic treatment of DL is safe and *** monotherapy and arterial(spurting) bleeding are associated with a high rate of bleeding recurrence.