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A single-center United States experience with bleeding Dieulafoy lesions of the small bowel: diagnosis and treatment with single-balloon enteroscopy.

Lipka S, Rabbanifard R, Kumar A, Brady P - Endosc Int Open (2015)

Bottom Line: In three patients, electrocoagulation was unsuccessful and hemostasis was achieved with clip placement.Three patients required repeat SBE with one found to have rebleeding from a failed clip with hemostasis achieved upon reapplication of one clip.In our United States' experience, SBE offers a reasonable therapeutic approach to treat DL of the small bowel with low rates of rebleeding, no adverse events, and no patient requiring surgery.

View Article: PubMed Central - PubMed

Affiliation: University of South Florida Morsani College of Medicine, Department of Medicine, Tampa, Florida, United States.

ABSTRACT

Introduction: A Dieulafoy lesion (DL) of the small bowel can cause severe gastrointestinal bleeding, and presents a difficult clinical setting for endoscopists. Limited data exists on the therapeutic yield of treating DLs of the small bowel using single-balloon enteroscopy (SBE).

Methods: Data were collected from Tampa General Hospital a 1 018-bed teaching hospital affiliated with University of South Florida in Tampa, Florida. Patients were selected from a database of patients that underwent SBE from January 2010 - August 2013.

Results: Eight patients were found to have DL an incidence of 2.6 % of 309 SBE performed for obscure gastrointestinal bleeding. 7/8 were identified in the jejunum, with one found in the duodenum. The mean age of patients with DL was 71.5 years old. 6/8 patients were on some form of anticoagulant/antiplatelet agent. The primary modality of therapy employed was electrocautery, multipolar electrocoagulation in seven patients and APC (argon plasma coagulation) in one patient. In three patients, electrocoagulation was unsuccessful and hemostasis was achieved with clip placement. Three patients required repeat SBE with one found to have rebleeding from a failed clip with hemostasis achieved upon reapplication of one clip.

Conclusion: In our United States' experience, SBE offers a reasonable therapeutic approach to treat DL of the small bowel with low rates of rebleeding, no adverse events, and no patient requiring surgery.

No MeSH data available.


Related in: MedlinePlus

Active bleeding from jejunal Dieulafoy lesion after initial argon plasma coagulation. b Cessation of bleeding after final argon plasma coagulation therapy.
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FI110-2: Active bleeding from jejunal Dieulafoy lesion after initial argon plasma coagulation. b Cessation of bleeding after final argon plasma coagulation therapy.

Mentions: The primary modality of therapy employed was electrocautery, multipolar electrocoagulation in seven patients and APC in one (Fig. 1 a, 1 b and Fig. 2 a, 2 b). Epinephrine injection was used as an adjuvant therapy to initially slow bleeding in two patients. In three patients, electrocoagulation was unsuccessful and hemostasis was achieved with clip placement (resolution clips) (Video 1 and Video 2). The average hospitalization for overt OGIB secondary to DL was 7.8 days (range, 2 – 27). The mean follow-up time for patients diagnosed with DL was 17.5 months (range, 1.5 – 44). Three patients required repeat SBE with one found to have rebleeding from a failed clip. Two patients requiring repeat SBE were treated initially with bipolar/clip (one patient treated with four clips and the second with one clip), and the third patient initially treated with epinephrine/bipolar therapy. The patient treated with four clips was found to have rebleeding occurring two weeks after the initial SBE and achieved hemostasis with reapplication of one clip. Repeat SBE was performed at two months and four months in patient five, however no rebleeding was noted at the tattooed area where the previous DL was identified. Patient number 8 had noted rebleeding 44 months post initial anterograde SBE; a subsequent anterograde SBE was negative for bleeding, and bleeding resolved with conservative management (Table 3 and Table 4).


A single-center United States experience with bleeding Dieulafoy lesions of the small bowel: diagnosis and treatment with single-balloon enteroscopy.

Lipka S, Rabbanifard R, Kumar A, Brady P - Endosc Int Open (2015)

Active bleeding from jejunal Dieulafoy lesion after initial argon plasma coagulation. b Cessation of bleeding after final argon plasma coagulation therapy.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554498&req=5

FI110-2: Active bleeding from jejunal Dieulafoy lesion after initial argon plasma coagulation. b Cessation of bleeding after final argon plasma coagulation therapy.
Mentions: The primary modality of therapy employed was electrocautery, multipolar electrocoagulation in seven patients and APC in one (Fig. 1 a, 1 b and Fig. 2 a, 2 b). Epinephrine injection was used as an adjuvant therapy to initially slow bleeding in two patients. In three patients, electrocoagulation was unsuccessful and hemostasis was achieved with clip placement (resolution clips) (Video 1 and Video 2). The average hospitalization for overt OGIB secondary to DL was 7.8 days (range, 2 – 27). The mean follow-up time for patients diagnosed with DL was 17.5 months (range, 1.5 – 44). Three patients required repeat SBE with one found to have rebleeding from a failed clip. Two patients requiring repeat SBE were treated initially with bipolar/clip (one patient treated with four clips and the second with one clip), and the third patient initially treated with epinephrine/bipolar therapy. The patient treated with four clips was found to have rebleeding occurring two weeks after the initial SBE and achieved hemostasis with reapplication of one clip. Repeat SBE was performed at two months and four months in patient five, however no rebleeding was noted at the tattooed area where the previous DL was identified. Patient number 8 had noted rebleeding 44 months post initial anterograde SBE; a subsequent anterograde SBE was negative for bleeding, and bleeding resolved with conservative management (Table 3 and Table 4).

Bottom Line: In three patients, electrocoagulation was unsuccessful and hemostasis was achieved with clip placement.Three patients required repeat SBE with one found to have rebleeding from a failed clip with hemostasis achieved upon reapplication of one clip.In our United States' experience, SBE offers a reasonable therapeutic approach to treat DL of the small bowel with low rates of rebleeding, no adverse events, and no patient requiring surgery.

View Article: PubMed Central - PubMed

Affiliation: University of South Florida Morsani College of Medicine, Department of Medicine, Tampa, Florida, United States.

ABSTRACT

Introduction: A Dieulafoy lesion (DL) of the small bowel can cause severe gastrointestinal bleeding, and presents a difficult clinical setting for endoscopists. Limited data exists on the therapeutic yield of treating DLs of the small bowel using single-balloon enteroscopy (SBE).

Methods: Data were collected from Tampa General Hospital a 1 018-bed teaching hospital affiliated with University of South Florida in Tampa, Florida. Patients were selected from a database of patients that underwent SBE from January 2010 - August 2013.

Results: Eight patients were found to have DL an incidence of 2.6 % of 309 SBE performed for obscure gastrointestinal bleeding. 7/8 were identified in the jejunum, with one found in the duodenum. The mean age of patients with DL was 71.5 years old. 6/8 patients were on some form of anticoagulant/antiplatelet agent. The primary modality of therapy employed was electrocautery, multipolar electrocoagulation in seven patients and APC (argon plasma coagulation) in one patient. In three patients, electrocoagulation was unsuccessful and hemostasis was achieved with clip placement. Three patients required repeat SBE with one found to have rebleeding from a failed clip with hemostasis achieved upon reapplication of one clip.

Conclusion: In our United States' experience, SBE offers a reasonable therapeutic approach to treat DL of the small bowel with low rates of rebleeding, no adverse events, and no patient requiring surgery.

No MeSH data available.


Related in: MedlinePlus