Clinical Features, Endoscopic Management and Outcome of Patients with Non-variceal Upper Digestive Bleeding by Dieulafoy Lesion

摘要

Aim and background: Dieulafoy lesion (DL) represents a rare, but important cause of major upper digestivebleeding, especially in elders. The aim of the study consists in identifying the clinico-biological and endoscopicfeatures and the outcome of these patients.Methods: We retrospectively evaluated the patients admitted with non-variceal upper digestive bleeding (UDB) inthe Department of Gastroenterology, of the Emergency County Hospital Timisoara, from 2003 to 2014. Out of thetotal number of cases we selected the patients with endoscopic diagnosis of Dieulafoy lesion. In these patients weanalyzed the demographic, clinico-biological and endoscopic data, compared to the control group that encounteredthe rest of the patients with UDB.Results: Out of 2104 patients with non-variceal UDB, 31/2104 (1.5%) presented DL, 19/31(61.3%) male and12/31(38.7%) female, mean age 63 ± 12.83. Diabetes mellitus was present in 35.5% cases. The mean value ofhemoglobin was significantly lower in Dieulafoy group 7 ± 2.69 vs. 8 ± 3.28 in the control group, p=0.05, thus asignificantly larger number of blood units per patient were needed in this group (p<0.0001). Re-bleebing wasencountered significantly more often in Dieulafoy vs. control group: 7/31(22.6%) vs. 173/2074 (8.34%), p=0.03;surgery was needed in 3/31(9.7%) Dieulafoy patients. Endoscopic haemostasis was achieved most frequently byusing combined treatment. The use of anticoagulants had a significant influence in the development of DL(p=0.019).Conclusion: DL may cause massive bleeding and is associated with a high rate of re-bleeding. Patients presentcomorbidities, diabetes mellitus being mostly associated with this condition. Anticoagulants represent risk factorshighly associated with DL.