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. 2023 Aug 24;23(1):290.
doi: 10.1186/s12876-023-02913-1.

Clinical characteristics of Dieulafoy's lesion in the small bowel diagnosed and treated by double-balloon endoscopy

Masanao Nakamura  1 , Takeshi Yamamura  2 , Keiko Maeda  2 , Tsunaki Sawada  3 , Eri Ishikawa  2 , Kazuhiro Furukawa  2 , Tadashi Iida  2 , Yasuyuki Mizutani  2 , Kentaro Yamao  3 , Takuya Ishikawa  2 , Takashi Honda  2 , Masatoshi Ishigami  2 , Hiroki Kawashima  2
Affiliations

Clinical characteristics of Dieulafoy's lesion in the small bowel diagnosed and treated by double-balloon endoscopy

Masanao Nakamura et al. BMC Gastroenterol. .

Abstract

Background: Obscure gastrointestinal bleeding refers to bleeding for which the source cannot be ascertained even through balloon-assisted endoscopy. In certain instances, Dieulafoy's lesion in the small bowel is presumed to be the underlying cause.

Aim: This retrospective study aimed to elucidate the clinical characteristics of Dieulafoy's lesion in the small bowel as diagnosed via double-balloon endoscopy while also exploring the feasibility of predicting bleeding from Dieulafoy's lesion prior to endoscopy in cases of obscure gastrointestinal bleeding.

Methods: A comprehensive analysis of our database was conducted, identifying 38 patients who received a diagnosis of Dieulafoy's lesion and subsequently underwent treatment via double-balloon endoscopy. The clinical background, diagnosis, and treatment details of patients with Dieulafoy's lesion were carefully examined.

Results: The median age of the 38 patients was 72 years, and 50% of the patients were male. A total of 26 (68%) patients exhibited a high comorbidity index. The upper jejunum and lower ileum were the most frequently reported locations for the occurrence of Dieulafoy's lesion in the small bowel. The detected Dieulafoy's lesions exhibited active bleeding (n = 33) and an exposed vessel with plaque on the surface (n = 5). Rebleeding after endoscopic treatment occurred in 8 patients (21%, median period: 7 days, range: 1-366 days). We conducted an analysis to determine the definitive nature of the initial double-balloon endoscopy diagnosis. Multivariate analysis revealed that hematochezia of ≥ 2 episodes constituted the independent factor associated with ≥ 2 double-balloon endoscopy diagnoses. Additionally, we explored factors associated with rebleeding following endoscopic treatment. Although the number of hemoclips utilized displayed a likely association, multivariate analysis did not identify any independent factor associated with rebleeding.

Conclusion: If a patient encounters multiple instances of hematochezia, promptly scheduling balloon-assisted endoscopy, equipped with optional instruments without delay is advised, after standard endoscopic evaluation with esophagogastroduodenoscopy and colonoscopy is unrevealing.

Keywords: Balloon-assisted endoscopy; Dieulafoy’s lesion; Obscure gastrointestinal bleeding; Rebleeding; Small bowel.

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Conflict of interest statement

Not applicable.

Figures

Fig. 1
Fig. 1
Dieulafoy’s lesion spurting blood from an exposed vessel on the surface that was covered by a clot
Fig. 2
Fig. 2
Dieulafoy’s lesion revealing an exposed vessel with red plaque
Fig. 3
Fig. 3
Kaplan-Meier curve for showing the time of rebleeding
See this image and copyright information in PMC

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