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Clinical outcome of endoscopic management of duodenal Dieulafoy’s lesions: endoscopic band ligation versus endoscopic hemoclip placement

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Abstract

Background

The most appropriate type of endoscopic hemostasis for bleeding due to duodenal Dieulafoy’s lesions (DLs) is not yet established. The aim of this study was to assess the efficacy of mechanical endoscopic hemostasis for duodenal DLs and long-term outcome after successful hemostasis, as well as to compare the efficacy and safety of endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP).

Methods

Patients admitted to the emergency unit with acute upper gastrointestinal bleeding from duodenal DLs were enrolled in this study. The data were collected prospectively, but data analysis was performed retrospectively. Twenty-four patients with duodenal DLs were treated with EBL (n = 11) or EHP (n = 13).

Results

There were no significant differences between groups with respect to clinical or endoscopic characteristics, apart from the number of epinephrine (three cases with EBL vs. 11 cases with EHP; p = 0.011). Primary hemostasis was achieved in all patients. Recurrent bleeding was observed in one patient (9.1 %) from the EBL group and in five patients (38.5 %) from the EHP group (p = 0.166). The recurrent bleeding in the patient from the EBL group was treated by EHP. In the EHP group, all five patients achieved successful secondary hemostasis by endoscopic treatment (EBL in two patients and EHP in three patients). There were no differences in secondary outcomes between the two groups, including the number of endoscopic sessions required, need for angiographic embolization or emergent surgery, transfusion requirements, or length of hospital stay. No complications occurred, and there was no recurrence of bleeding in either group during the follow-up period.

Conclusions

Mechanical endoscopic treatments are effective and safe for the treatment of bleeding duodenal DLs. A large-scale, randomized, controlled study is required to confirm the efficacy and safety of EBL and EHP for the management of bleeding duodenal DLs.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Incheon, 21431, Korea

    Jeong-Seon Ji

  2. Division of Gastroenterology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu, 11765, Korea

    Hyung-Keun Kim, Sung Soo Kim & Hiun-Suk Chae

  3. MOT Cluster, Korea University of Technology and Education, 1600 Chungjeol-ro, Cheonan, 31253, Korea

    Hyunjung Cho

  4. Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, 06591, Korea

    Young-Seok Cho

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  1. Jeong-Seon Ji
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Correspondence to Young-Seok Cho.

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Disclosures

Jeong-Seon Ji, Hyung-Keun Kim, Sung Soo Kim, Hiun-Suk Chae, Hyunjung Cho, and Young-Seok Cho have no conflict of interest or financial ties to disclose.

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Ji, JS., Kim, HK., Kim, S.S. et al. Clinical outcome of endoscopic management of duodenal Dieulafoy’s lesions: endoscopic band ligation versus endoscopic hemoclip placement. Surg Endosc 30, 3526–3531 (2016). https://doi.org/10.1007/s00464-015-4642-7

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  • DOI: https://doi.org/10.1007/s00464-015-4642-7

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