26例内镜下金属钛夹治疗Dieulafoy病的临床研究

目的探讨内镜下钛夹止血治疗Dieulafoy病的临床疗效。方法收集整理我院经胃镜明确诊断上消化道Dieulafoy病并出血的26例患者的症状、胃镜下特点,并对内镜下止血术方法进行分析研究。结果 26例Dieulafoy病患者均表现上消化道出血,病灶位于胃小弯距贲门6cm以内占73.1%(19/26),早期止血成功率为100%,治疗前后的出血率比较,具有统计学意义(P0.01)。结论经胃镜下金属钛夹置放术是目前临床上治疗上消化道Dieulafoy病最常见最重要治疗手段之一。     

急诊内镜联合选择性动脉造影诊治Dieulafoy病4例临床分析

目的探讨急诊内镜联合选择性动脉造影诊治Dieulafoy病的临床价值。方法我院消化内科2009年1月1日～2010年12月31日共收治Dieulafoy病18例,对其中急诊内镜联合选择性动脉造影救治Dieulafoy病所致上消化道大出血4例进行临床分析,通过急诊内镜联合选择性动脉造影的协同应用,观察对出血部位、病因的诊断价值和止血效果。结果 4例患者均在就诊1～24h内胃镜检查确诊Dieulafoy病,其中3例给予镜下钛夹止血或药物喷洒止血后仍有活动性出血随即行选择性动脉造影血管栓塞治疗,1例因镜下出血表现为喷射样,并血压下降,给予病灶旁钛夹标记后随即行选择性动脉造影血管栓塞治疗。本组4例在选择性动脉造影同时结合内镜所见均给予相应病变血管弹簧栓或明胶海绵栓塞止血治疗并成功止血。结论急诊内镜联合选择性动脉造影血管栓塞术协同诊治Dieulafoy病所致消化道出血,两者互为补充,是一种安全、有效、可靠的诊治方法。     

Dieulafoy病内镜诊治中的几个问题探讨（附22例报告）

目的 探讨上消化道粘膜下恒径小动脉破裂出血(Dieulafoy病)的内镜诊断与治疗.方法 对2005-04-2008-02胃镜检查诊断的22例Dieulafoy病住院病例进行分析.结果 22例患者用HLE液内镜粘膜下注射治疗,1次注射止血有效率77.3%,2次注射止血总有效率86.4%,有3例注射治疗后仍有活动性出血行手术治疗.平均住院天数11.7 d.结论 对于Dieulafoy引起的上消化道大出血,内镜FILE液粘膜下注射治疗是有效的;诊断上需与消化性溃疡、肿瘤等引起上消化道出血的原因相鉴别.     

Dieulafoy病34例内镜治疗的护理

目的探讨上消化道Dieulafoy病内镜治疗的护理。方法对34例Dieulafoy病进行回顾性分析和总结。结果 34例患者中,29例经内镜治疗后出血停止;手术5例,其中3例因出血内镜下诊视不清转外科手术治疗;1例内镜检查后次日再发上消化道大出血、失血性休克,抢救稳定后转外科手术;1例89岁高龄患者内镜检查两次均因胃底巨大血凝块,治疗失败转外科手术手术。结论 Dieulafoy病主要表现为间歇性、无痛性消化道大出血,严重者可出现失血性休克,具有较高的病死率,急诊内镜检出和及时处理,做好健康教育,对提高治疗效果,促进患者康复具有重要意义。     

内镜注射联合金属钛夹治疗上消化道动脉喷射状出血的疗效观察

目的 观察内镜下黏膜内注射高渗盐-肾上腺素溶液联合金属止血夹治疗上消化道动脉喷射状出血的效果。方法 1999-07／2004-11共16例病人因呕血和／或黑便接受胃镜检查时发现病灶呈喷射状出血，诊断胃溃疡8例，胃癌1例(溃疡型)，Dieulafoy病5例，胃巨大息肉摘除术后出血2例。全部病例应用内镜下黏膜注射高渗盐-肾上腺素溶液，随后置放金属止血夹。结果 16例应用内镜下黏膜注射高渗盐-肾上腺素溶液联合金属止血夹疗法，均一次止血成功，无一例发生再出血和其它并发症，止血成功率100％。12例病人在6～10周内复查胃镜提示病灶愈合，1例胃癌病人止血后转外科手术治疗。结论 内镜注射联合金属钛夹治疗上消化道动脉喷射状出血止血迅速，疗效可靠，再出血率低，操作简便、安全，具有较高的临床实用价值。     

Dieulafoy病的诊治分析

目的 研究Dieulafoy病患者的内镜下表现及转归.方法 18例 Dieulafoy 病患者均经内镜检查确诊.结果 患者病灶主要位于贲门胃底6例,胃体上段小弯5例,胃窦3例,球部2例,球后部1例.患者均行内镜下钛夹止血,止血成功17例,1例转外科手术治疗.结论 Dieulafoy病是引起消化道出血的较常见病因,内镜下...     

上消化道Dieulafoy病34例诊治分析

目的：探讨上消化道Dieulafoy病的临床特点、诊断及治疗。方法：对34例Dieulafoy病进行回顾性分析和总结。结果：上消化道Dieulafoy病是黏膜下恒径小动脉畸形,主要表现为间歇性、无痛性消化道大出血。采用急诊内镜检查和内镜治疗效果明显。结论：Dieulafoy病的临床表现和内镜特征是提高诊断率,减少漏、误诊的关键,内镜为Dieulafoy病的诊断和治疗的首选方法,具有良好的安全性及有效性。     

急诊内镜下双向法注射治疗胃高位非静脉曲张出血36例临床观察

急诊内镜检查能早期明确上消化道出血原因 ,发现出血病灶 ,并能直视下进行止血治疗 ,故其应用受到临床医师的重视。现急诊内镜治疗已成为首选止血方法 [1]。但是胃高位出血采用常规注射方法 ,容易造成失败[2 ,3 ] 。1 993年 6月～ 2 0 0 1年 1 0月 ,我院共行急诊胃镜检查 5 81例 ,检出胃高位非静脉曲张破裂出血 36例 ,同时采用双向法内镜下注射止血 ,取得了较好的疗效。现报告如下。1　资料与方法1 .1　一般资料　本组男 2 9例 ,女 7例 ;年龄 1 5～ 80岁 ,平均 49.6岁。出血原因 :贲门癌 4例 ,胃癌 7例 ,胃溃疡 1 5例 ,Dieulafoy病 1 0例。…     

内镜下无水酒精注射治疗Dieulafoy病

Dieulafoy病又称胃粘膜下恒径动脉破裂出血,是一种并非罕见的上消化道出血性疾病,病灶小,位置特殊,诊断比较困难。自开展急诊内镜以来,该病发现率有所增高。从1995年以来我院对急诊胃镜发现的Dieulafoy病进行内镜下无水酒精注射治疗,效果满意。     

Dieulafoy病术后残胃再发出血1例报道并文献复习

Dieulafoy病是少见的上消化道大出血原因之一,临床资料相对较少,发病机制尚不明确,目前诊断及治疗均以内镜为主。而Dieulafoy病胃大部切除术后残胃再发Dieulafoy病更为罕见,本文报道1例并就相关文献进行复习,探讨可能的发病机制,总结临床治疗经验,以期对该病有更进一步认识。     

Dieulafoy lesions: a review of 6 years of experience at a tertiary referral center

Dieulafoy lesions are uncommon sources of GI hemorrhage and predominantly occur in the proximal stomach. At one time a pathological diagnosis made postoperatively, Dieulafoy lesions are now routinely diagnosed and treated endoscopically. Their true incidence is unclear as quiescent Dieulafoy lesions are easily overlooked on endoscopy and bleeding lesions are occasionally misidentified. Over 6 yr (June 1993-November 1999), 40 Dieulafoy lesions were identified on upper endoscopy at our institution, of which seven were located in the duodenum and one in the right colon. Forty-seven percent of patients were hospitalized for other causes before onset of bleeding, and 17 of 40 were found to have other abnormal findings at endoscopy. In 90% of the cases, endoscopic treatment was successful. Seven patients died, but none as a result of hemorrhage. In 24 endoscopically-treated patients in whom follow-up data are available, Dieulafoy bleeding recurred in one patient. Dieulafoy lesions are rare and often difficult to diagnose, but must be considered in the evaluation of upper and lower GI tract hemorrhage, as they can usually be managed endoscopically.     

Dieulafoy’s disease treated by endoscopic haemostatic clipping

Dieulafoy’s disease is an uncommon cause of upper gastrointestinal haemorrhage. We report three patients with Dieulafoy’s disease treated with the endoscopic haemostatic clip application. There was no recurrent bleeding from the upper gastrointestinal tract after application of the clips in all three patients. Two patients survived while the third succumbed to renal failure after hypovolaemic shock. We conclude that endoscopic haemostatic clip may have a role in the treatment of Dieulafoy’s disease.     

Endoscopic treatment of Dieulafoy hemorrhage

Bleeding from a Dieulafoy lesion is an underdiagnosed source of upper gastrointestinal bleeding. The literature is almost universally in support of surgical therapy as its treatment. We report three patients with bleeding Dieulafoy lesions who were treated successfully with endoscopic therapy--two by bipolar electrocoagulation and one by endoscopic sclerotherapy.     

Dieulafoy lesion in mid-esophagus with esophageal varices.

Dieulafoy lesion is an uncommon cause of gastrointestinal (GI) bleeding. Most such lesions are reported in the stomach, though a few have been reported in the distal esophagus. We report a 54-year-old man who presented with upper GI bleeding and had esophageal varices but bled from a Dieulafoy lesion 5 cm above the proximal end of the varices.     

Endoscopic Hemostasis in Patients with Dieulafoy Ulcer

Abstract: Dieulafoy ulcer was defined based on endoscopic findings as an ulcer (1) of 10 mm or less in diameter, (2) of grade Ul-ll or less and (3) showing vascular protrusion in its floor. We evaluated the clinical background and endoscopic findings of Dieulafoy ulcer and studied the usefulness and problems of endoscopic hemostasis. Patients with Dieulafoy ulcer accounted for 8.7 % of 321 patients with diseases treated by endoscopic hemostasis excluding sclerotherapy. The patients were predominantly males, and their average age was 61 years. An association with other diseases was noted in 21 patients (75%). Therefore, more than 50 % of the patients were treated with NSAIDs such as aspirin. The most frequent site of this disease was the posterior wall of the upper gastric body. In particular, the ulcer was located in the superior duodenal angle. In six of the 28 patients, the ulcer and the exposed vessel were similar in size. Endoscopic hemostasis was successful in 25 patients (89%). Hemostasis was acheived by emergency surgery in two and by transcatheter arterial embolization (TAE) in one. No patient showed recurrence. Most Dieulafoy ulcers can be conservatively treated by endoscopic hemostasis. However, a few cases can not be managed conservatively and shock develops due to fatal massive bleeding. In such patients, the timing of TAE or surgery must be carefully considered.     

Endoscopic ultrasound (EUS)-guided angiotherapy of refractory gastrointestinal bleeding

BACKGROUND: There are well-established methods for treating gastrointestinal (GI) bleeding, although some lesions prove refractory to conventional techniques. Little consideration has been directed toward the use of endoscopic ultrasound (EUS) in the management of refractory bleeding. AIMS: To discuss patient selection, technique, and clinical outcomes for EUS-guided angiotherapy for severe refractory bleeding after conventional therapies. METHODS: The EUS database was reviewed to identify all patients who underwent EUS-directed angiotherapy. RESULTS: Five patients, four with severe bleeding from hemosuccus pancreaticus, Dieulafoy lesion, duodenal ulcer, or gastrointestinal stromal tumor (GIST) and one with occult GI bleeding, had an average of three prior episodes (range 2-4) of severe bleeding and had received 18 (range 14-25) units of packed red blood cells (PRBC). All had failed in at least two conventional attempts to control the bleeding. Under EUS guidance, 99% alcohol was injected (4-7 mL) in two patients, one each with a pancreatic pseudoaneurysm and a duodenal Dieulafoy lesion. In three other patients, cyanoacrylate (3-5 mL) was injected into a duodenal ulcer, and in two patients with a GIST. No patient rebled and no complications were reported. CONCLUSIONS: EUS-guided angiotherapy appears safe and effective in managing selected patients with clinically severe or occult GI bleeding from lesions potentially refractory to standard endoscopic and/or angiographic techniques. Further studies are needed to confirm the safety and efficacy and to refine the selection criteria in an effort to improve patient care.     

Jejunal Dieulafoy lesion with intraintestinal calcification on computerized tomography: A case report

Rationale:A Dieulafoy lesion is a rare cause of gastrointestinal (GI) bleeding, especially in the jejunum, and the presence of calcifications on CT might be suspicious of the diagnosis.Patient concerns:We describe a 72-year-old woman with anemia and melena. Hemoglobin was 6.0 g/dL, and the stools were positive for occult blood (4+). Blood pressure was 116/54 mm Hg. Physical examination showed pale face and pitting edema in both lower limbs. Abdominal computerized tomography showed calcification in the small intestine of the left lower abdomen. Capsule endoscopy showed a blood clot.Diagnoses:Dieulafoy lesion.Interventions:Single balloon endoscopy was performed via the oral approach and showed a blood clot on the suspected submucosal tumor of jejunum. A hemostatic clip was placed at the base of the lesion to allow the surgeon to locate it during the operation. Laparoscopy was performed, and the lesion was resected.Outcomes:The postoperative pathology showed a Dieulafoy lesion. The lower extremity edema subsided. GI bleeding did not recur over 1 year of follow-up, and hemoglobin was 12.2 g/dL. A Dieulafoy lesion is a rare cause of GI bleeding, and it is even rarer in the jejunum.Lessons:A Dieulafoy lesion does not have special imaging features, but the presence of calcifications in the small intestine on computerized tomography might be suspicious of the diagnosis. When endoscopic treatment is difficult, surgical treatment could be considered.     

Dieulafoy's disease: endoscopic treatment and follow up.

The findings from 480 patients who had emergency endoscopy for acute upper gastrointestinal bleeding of non-variceal origin at our institution were analysed. Twenty eight patients (5.8%) had a Dieulafoy lesion. In 27 patients (96.4%) bleeding could be successfully managed by injection of norepinephrine and polidocanol, in repeated sessions if needed. Two patients had to be treated surgically: one because of uncontrollable bleeding from the Dieulafoy lesion and one despite endoscopic control of the bleeding Dieulafoy lesion because of a concomitant bleeding from an anastomosal ulcer after gastric resection. Three patients died during hospital stay from causes unrelated to bleeding from Dieulafoy lesion. Out of the 25 patients discharged from the hospital 21 treated by endoscopy and two treated with surgery were followed up for a mean of 28.3 and 22.5 months, respectively. Twenty endoscopically treated patients (95%) had no recurrence of Dieulafoy's bleeding. One patient experienced severe rebleeding from the original site after a transient endoscopy confirmed complete disappearance. He had emergency operation without a further attempt to control bleeding by endoscopy. It is concluded that bleeding from Dieulafoy's disease can be successfully managed by endoscopic injection treatment. The longterm outcome is favourable.     

Factors associated with failure of initial endoscopic hemoclip hemostasis for upper gastrointestinal bleeding

BACKGROUND: Endoscopic hemoclip is widely used for the management of bleeding peptic ulcers. The major difficulty in clinical application of the hemoclip is deployment to the lesion during initial hemostasis. The aim of this study was to define factors associated with the failure of endoscopic hemoclip for initial hemostasis of upper GI bleeding. PATIENTS AND METHODS: From January to December 2003, we prospectively studied 77 randomized patients with clinical evidence of upper GI bleeding due to either active bleeding or a visible vessel identified by upper GI endoscopy in our emergency department. RESULTS: Among the 77 patients, 13 (16.9%) failed treatment (Group 1) and 64 (83.1%) were successfully (Group 2) treated by endoscopic hemoclip for lesions related to upper GI bleeding. There were no differences due to gender, blood pressure, initial heart rate, and hemoglobulin before or after endoscopic treatment, platelet count, serum creatinine, and albumin between groups. The mean age of Group 1 was higher than that of Group 2 (73.31+/-9.38 years vs. 65.41+/-16.45 years, respectively; P=0.083). Most patients who did not achieve initial hemostasis by endoscopic hemoclip had upper GI lesions over the gastric antrum and duodenal bulb. Among the 13 patients who failed to achieve endoscopic hemoclip initial hemostasis, four lesions were located over the posterior wall of the antrum, and four lesions over the lesser curvature side of the duodenal bulb. CONCLUSION: Endoscopic hemoclip is an effective hemostatic method for upper GI bleeding. Age, gastric antrum, and duodenal bulb lesions may be associated with the failure of initial hemostasis by endoscopic hemoclip.     

Submucosal hematoma is a highly suggestive finding for amyloid light-chain amyloidosis: Two case reports

The clinical and endoscopic features of amyloid lightchain(AL) amyloidosis are diverse and mimic various other diseases.Endoscopically,few reports on submucosal hematomas of the gastrointestinal(GI) tract are available in the literature.Here,we report two cases of AL amyloidosis presenting as submucosal hematomas in the absence of clinical disease elsewhere in the body.The 2 cases were referred to our hospital because of hematochezia.The endoscopic findings in both cases were similar in submucosal hematoma formation.However,the clinical courses differed.In the first case,there was no evidence of systemic amyloidosis and the disease was conservatively managed.In the second case,the disease progressed to systemic amyloidosis and the patient died within a short time.We conclude that the endoscopic detection of a submucosal hematoma in the setting of GI bleeding should raise suspicion of AL amyloidosis.Referral to a hematologist should be done immediately for treatment while the involvement is limited to the GI tract.