The Analysis Of Clinical Features Of Dieulafoy's Leision In Upper Gastrointestinal Tract And Effectiveness Of Endoscopic Injection Sclerosis

Background and aimsDieulafoy's leision (DL) is a potentially life-threatening cause of massive upper gastrointestinal (GI) hemorrhage. Therapeutic endoscopy is the first-select method of curing DL. The aim of this article was to investigation the clinical and endoscopic features of upper gastrointestinal DL and to Summary the curative effect of endoscopic injection sclerosis(EIS).MethodsAnalyses retrospectively the clinical and endoscopic features of nineteen-nine patients with upper gastrointestinal DL and the the curative effect of endoscopic injection sclerosis.Results1. Clinical featuresThis group of 19 patients with bleeding Dieulafoy's lesion in uppergastrointestinal tract, consisted of 15 male and 4 female patients(M:F=3.75:1) ,with a mean age of 54.6 years (ranged from 24 to 78years) .The history of chronic diseases was coexisted in 10 patients( 52.6%) .The utilization of non-steroidal anti-inflammatory drugs(NSAID) was present in 2 paients (10.5%) .The history of ingestionalcohol were present in 4 patients (21.1%) .The history of smoking wereassociated with 4 patients (21.1%) .Acute and intermittence hematemesisand melena were the leading symptoms of DL. There were 15 patients(78.9%) admitted for hematemesis accompanied with melena, 2 patients(10.5%) for hematemesis merely, 2 patients (10.5%) for melena merely,and 5 patients(26.3%)in the group accompanied with hemorrhagic shock.2. Location of lesion Each of this group of 19 patients had only one Dieulafoy's lesion in upper gastrointestinal tract. Dieulafoy's lesion was located in the stomach in 16 patients (84.2%) ,which within 6cm of the esophagogastric junction was presented in 14 patients (73.7%) , in the gastrointestinal anastomotic stoma in 2 patients (10.5%) ,in the duodenal bulb in 2 patients (10.5%) .3. Endoscopic featuresThe DL presented an isolated minute round or elliptical mucosal defect in 16 cases (84.2%) ,and all lesions' sizes range from 2 to 3 mm and borders were sharp, and there wasn't inflammatory reaction around them. There was visualization of a protruding arteriole in the middle of the defect ,with active impulsivity spurting, with errhysis on the naked vessel, or adherent clot. Lesions presenting active arterial spurting bleeding from normal mucosa counted to 5.3% (1/19) , conus-form polypoid appearance counted to 5.3% (1/19) ,fresh adherent punctiform clot on normal mucosa counted to 5.3% (1/19) .4. Effectiveness of EISThe rate of initial hemostasis of this grope was 84.2%, permanent hemotasis 89.5%, rebleeding26.3%, transfer into surgery 10.5%. The rate of complication was 10.5%.Conclusion1 .Dieulafoy's leision (DL) is commonly in male those above 50 years. Some chronic diseases (such as hypertension) or ingestion alcohol or non-steroidal anti-inflammatory drug long-term are probably the reasons to induce the occurrence of DL bleeding or aggravate the pathogenetic condition.2. DL in upper GI tract is most commonly located within 6cm of the esophagogastric junction. DLs have many endoscopic appearances. The lesion presents mostly an isolated minute round or elliptical mucosal defect, of which the size range from 2 to 3 mm and border is sharp, and there isn't inflammatory reaction around it. There was visualization of a protruding arteriole in the middle of the defect ,with active impulsivity spurting, with errhysis on the naked vessel, or adherent clot.3. EIS is one of the effective methods to cure the DL in upper GI tract. It's operation is easy and it's rate of haemostasis is high. But, it's rate of rebleeding is high.