Dieulafoy lezyonu saptanan hastaların retrospektif analizi

Yıl 2023, Cilt: 22 Sayı: 3, 136 - 141, 22.12.2023

Bünyamin Sarıtaş , Şehmus Ölmez Adnan Taş Nevin Akçaer Öztürk Banu Kara

https://doi.org/10.17941/agd.1322148

Cited By: 1

Öz

Giriş ve Amaç: Gastrointestinal kanamalar klinik pratikte sıklıkla karşılaşılan acil durumlardandır. Erken tanı ve uygun tedavi esastır. Dieulafoy lezyonu etrafındaki mukozayı erode eden aberran submukozal damardır. Bu lezyonlar gastrointestinal kanamaların %1-2’sine neden olur. Burada üst gastrointestinal kanama ile başvuran ve Dieulafoy lezyonu saptanan vakalarımızı sunacağız. Gereç ve Yöntem: Ağustos 2017-Ağustos 2021 tarihleri arasında üst gastrointestinal kanama nedeniyle hastanemize başvuran ve Dieulafoy lezyonu saptanan hastalar çalışmaya alındı. Hastaların dosyaları tarandı. Uygulanan tedaviler ve tedavi sonlanımları kaydedildi. Bulgular: Çalışmaya 30 hasta alındı. Ortalama yaş 65.9 ± 18.2 (20 - 92) idi. Hastaların yarısı kadındı. En sık başvuru sebepleri melana, hematemez ve hematokezya idi. Birlikte görülen hastalıklar hipertansiyon, aterosklerotik kalp hastalığı ve diabetes mellitus idi. Yirmi altı (%86.7) hastada Dieulafoy lezyonu ilk endoskopi ile tanı konulabilirken, 4 hastada ise ikinci endoskopide tanı konulabildi. Hastaneye başvuru ile ilk endoskopi arasındaki süre 3.1 ± 2.5 (1 - 10) saat idi. Yirmi üç hastada Dieulafoy lezyonu mide içerisinde, 6 hastada duodenumda ve 1 hastada da özofagusta görüldü. Tüm hastalara endoskopik tedavi yapıldı. En sık uygulanan endoskopik tedavi modalitesi skleroterapi ve hemoklip uygulaması idi. Bir hastada tekrarlayan kanama olması nedeniyle cerrahi gerekti. Altı hasta eksitus oldu. Bu hastaların üçünde eksitus nedeni kanama ile ilişkili idi. Sonuç: Dieulafoy lezyonu nadir fakat gastrointestinal kanamaların önemli bir sebebidir. Erken tanı ve uygun tedavi önemlidir. Tanı için tekrarlayan endoskopi gerekli olabilir. Hemoklip uygulaması skleroterapi ile veya skleroterapi olmaksızın ucuz, kolay, güvenli ve etkili bir tedavi yöntemidir.

Anahtar Kelimeler

Dieulafoy lezyonu, üst gastrointestinal kanama, tedavi, hemoklip

Retrospective analysis of patients with Dieulafoy’s lesions

Öz

Background and Aims: Gastrointestinal bleeding is an emergent condition in clinical practice. Early diagnosis and proper treatment of the lesion is essential. Dieulafoy's lesion is an aberrant submucosal vessel eroding surrounding mucosa. These lesions cause of 1-2% of all gastrointestinal bleedings. Here we report cases with Dieulafoy's lesion presenting with upper gastrointestinal bleeding. Materials and Methods: Through a time frame of between August 2017-August 2021, patients admitted to our hospital presenting with upper gastrointestinal bleeding and diagnosed as Dieulafoy’s lesion were included in the study. Patients' files were screened retrospectively. Results: The study included 30 patients with a mean age of 65.9 ± 18.2 (20 - 92) years. Half of them were female. The most observed presentations were melena, hematemesis, and hematochezia. Associated diseases were hypertension, atherosclerotic heart disease and diabetes mellitus. In 26 (86.7%) patients, Dieulafoy's lesion was diagnosed in first endoscopy, while in four patients Dieulafoy's lesion was diagnosed in second endoscopy. Time interval between hospital admission to first endoscopy was 3.1 ± 2.5 (1 - 10) hours. In 23 patients Dieulafoy's lesion was in the stomach and in 6 patients in duodenum and in 1 patient in esophagus. Endoscopic therapy was applied to all patients. The most applied treatment modality was sclerotherapy + hemoclip application. One patient had required surgery due to recurrent bleeding. Six patients died. Three of them was bleeding related. Conclusion: Dieulafoy's lesion is a rare but serious cause of gastrointestinal bleedings. Early diagnosis and proper treatment is important. Patients may need repeated endoscopy for diagnosis. Hemoclip application is cheap, easy, safe, and effective treatment modality with/without sclerotherapy.

Anahtar Kelimeler

Dieulafoy, upper gastrointestinal bleeding, hemoclip, treatment

Kaynakça

• 1. Baxter M, Aly EH. Dieulafoy's lesion: current trends in diagnosis and management. Ann R Coll Surg Engl 2010;92:548-54.
• 2. Inayat F, Ullah W, Hussain Q, Abdullah HMA. Dieulafoy's lesion of the colon and rectum: a case series and literature review. BMJ Case Rep 2017;2017:bcr2017220431.
• 3. Lai Y, Rong J, Zhu Z, et al. Risk factors for rebleeding after emergency endoscopic treatment of Dieulafoy lesion. Can J Gastroenterol Hepatol 2020;2020:2385214.
• 4. Paccos JL, Mukai NS, Correa PAFP, et al. Dieulafoy lesion in the colon: a rare cause of lower gastrointestinal bleeding. Endoscopy 2021;53:E313-E314.
• 5. Jeon HK, Kim GH. Endoscopic management of Dieulafoy's lesion. Clin Endosc 2015;48:112-20.
• 6. Nojkov B, Cappell MS. Gastrointestinal bleeding from Dieulafoy's lesion: Clinical presentation, endoscopic findings, and endoscopic therapy. World J Gastrointest Endosc 2015;7:295-307.
• 7. Chakinala RC, Solanki S, Haq KF, et al. Dieulafoy's lesion: Decade-long trends in hospitalizations, demographic disparity, and outcomes. Cureus 2020;12:e9170.
• 8. Kim JS, Kim BW, Kim DH, et al. Guidelines for nonvariceal upper gastrointestinal bleeding. Gut Liver 2020;14:560-70.
• 9. Jain R, Chetty R. Dieulafoy disease of the colon. Arch Pathol Lab Med 2009;133:1865-7.
• 10. Wuerth BA, Rockey DC. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: A nationwide analysis. Dig Dis Sci 2018;63:1286-93.
• 11. Watari J, Yamasaki T, Kondo T, et al. Morphological changes of colonic Dieulafoy's lesion: a case that could be retrospectively reviewed in a patient without treatment. Clin J Gastroenterol 2011;4:351-4.
• 12. Massinha P, Cunha I, Tomé L. Dieulafoy lesion: Predictive factors of early relapse and long term follow-up. GE Port J Gastroenterol 2020;27:237-43.
• 13. Shin HJ, Ju JS, Kim KD, et al. Risk factors for Dieulafoy lesions in the upper gastrointestinal tract. Clin Endosc 2015;48:228-33.
• 14. Ding YJ, Zhao L, Liu J, Luo HS. Clinical and endoscopic analysis of gastric Dieulafoy's lesion. World J Gastroenterol 2010;16:631-5.
• 15. Kishino T, Tanaka S. Colonic Dieulafoy lesion successfully treated by endoclips: a rare cause of lower gastrointestinal bleeding. Endoscopy 2020;52:E49-E50.
• 16. Kinoshita K, Matsunari O, Sonoda A, et al. A case of the lower gastrointestinal bleeding due to Dieulafoy's ulcer in the cecum. Clin J Gastroenterol 2020;13:564-7.
• 17. Beyazit Y, Disibeyaz S, Suvak B, et al. [Evaluation of treatment results among patients with acute gastrointestinal bleeding due to Dieulafoy's lesion admitted to the emergency department]. Ulus Travma Acil Cerrahi Derg 2013;19:133-9.
• 18. Barakat M, Hamed A, Shady A, Homsi M, Eskaros S. Endoscopic band ligation versus endoscopic hemoclip placement for Dieulafoy's lesion: a meta-analysis. Eur J Gastroenterol Hepatol 2018;30:995-6.