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The efficacy of sclerotherapy as the initial treatment in patients with bleeding from Dieulafoy's lesion of the upper gastrointestinal tract.
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . Jul2024, Vol. 38 Issue 7, p3773-3782. 10p. - Publication Year :
- 2024
-
Abstract
- Background: Dieulafoy's lesion (DL) is a rare and important cause of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), however, there is a lack of clear guidelines focus on the endoscopic hemostasis treatment for DL. Sclerotherapy, as the ANVUGIB guideline recommended endoscopic hemostasis method, is widely used in clinical practice. The aim of this study is to investigate the efficacy of sclerotherapy as the initial treatment for Dieulafoy's lesion of the upper gastrointestinal tract (UDL). Methods: Patients with UDL who underwent the ANVUGIB standard endoscopic hemostasis between April 2007 and January 2023 were enrolled. The endoscopic therapy method was left to the discretion of the endoscopist. Results: In total, 219 patients were finally obtained, with 74 (33.8%) receiving sclerotherapy and 145 (66.2%) receiving other standard endoscopic therapy. The rebleeding within 30 days was significantly lower in the sclerotherapy group compared to the other standard group (5.8% vs. 16.8%, p = 0.047). There were no significant differences between the two groups in terms of successful hemostasis rate (93.2% vs. 94.5%, p = 0.713), median number of red blood cell transfusions (3.5 vs. 4.0 units, p = 0.257), median hospital stay (8.0 vs. 8.0 days, p = 0.103), transferred to ICU rate (8.1% vs. 6.2%, p = 0.598), the need for embolization or surgery rate (12.2% vs. 9.7%, p = 0.567) and 30-day mortality (0 vs. 2.1%, p = 0.553). In addition, we found no difference in efficacy between sclerotherapy alone and combination (3.1% vs. 8.1%, p = 0.714). Further analysis revealed that thermocoagulation for hemostasis was associated with a higher rate of rebleeding (28.6% vs. 3.1%, p = 0.042) and longer hospital stay (11.5 vs. 7.5 days, p = 0.005) compared to sclerotherapy alone. Conclusion: Sclerotherapy represents an effective endoscopic therapy for both alone and combined use in patients with upper gastrointestinal Dieulafoy's lesion. Therefore, sclerotherapy could be considered as initial treatment in patients with bleeding of UDL. [ABSTRACT FROM AUTHOR]
- Subjects :
- *GASTROINTESTINAL hemorrhage treatment
*RED blood cell transfusion
*MORTALITY
*RESEARCH funding
*ERYTHROCYTES
*T-test (Statistics)
*DATA analysis
*ENDOSCOPIC hemostasis
*HOSPITAL care
*THERAPEUTIC embolization
*FISHER exact test
*TREATMENT effectiveness
*RETROSPECTIVE studies
*MANN Whitney U Test
*CHI-squared test
*DESCRIPTIVE statistics
*SCLEROTHERAPY
*GASTRIC mucosa
*ELECTROCOAGULATION (Medicine)
*INTENSIVE care units
*COMBINED modality therapy
*SOMATOSTATIN
*STATISTICS
*COMPARATIVE studies
*LENGTH of stay in hospitals
*DISEASE relapse
*DATA analysis software
DIGESTIVE organ surgery
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 38
- Issue :
- 7
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 178230371
- Full Text :
- https://doi.org/10.1007/s00464-024-10854-3