The Usefulness of Positional Change in Endoscopic Hemostasis for Bleeding Dieulafoy's Lesion

Lee, Jae Hak; Lee, Suck Ho; Bae, Won Yeop; Park, Jeong Hoon; Park, Do Hyun; Chung, Il Kwun; Park, Sang Heum; Kim, Sun Joo

Abstract

BACKGROUND/AIMS: Dieulafoy's lesion is a rare cause of massive upper gastrointestinal bleeding, most commonly in the proximal stomach. Although the mechanical hemostatic method has been widely used, it is difficult to access for complete application. This study evaluated the utility of a positional change in patients with a bleeding Dieulafoy's lesion.
METHODS
Between January 2003 and March 2004, 15 patients with a bleeding Dieulafoy's lesion were randomly assigned to either a positional change group (right decubitus or supine, n=7) or a left decubitus group (n=8). The demographic characteristics, endoscopic variables, and clinical outcomes were analyzed.
RESULTS
The patients' characteristics at entry were similar in both groups. Initial hemostasis was achieved in all patients. Recurrent bleeding developed in only one patients in the left decubitus group. The mean procedure time was significantly shorter in the positional change group than in the left decubitus group (4.5+/-3.4 min vs. 7.4+/-5.2 min, p<0.05). The ineffective hemoclip number (respectively, 0.3+/-0.1 vs. 1.4+/-1.2, p<0.05) was significantly different in the two groups. No major procedure-related complications occurred in the positional change group.
CONCLUSIONS
Endoscopic hemostasis with a positional change is an effective and safe method for treating in a bleeding Dieulafoy's lesion.