Aralik 2020
Dieulafoy lezyonu tanili hastalarda endoskopik tedavi basarisi ve takip sonuçlari
Success of endoscopic treatment in patients with dieulafoy lesion and follow-up results
- Ana Sayfa
- Sayılar
- Aralik 2020
- Dieulafoy lezyonu tanili hastalarda endoskopik tedavi basarisi ve takip sonuçlari...
Özet
Giris ve Amaç: Klinigimizde Dieulafoy lezyonu tanisi konulan hastalar için yapilan endoskopik tedavileri, bu endoskopik tedavilerin basari ve komplikasyon oranlarini ve islem sonrasi takip döneminde gelisen yeniden kanama ve hastaneye yatis oranlarini tespit etmeyi amaçladik. Gereç ve Yöntem: Haziran 2015 - Haziran 2020 tarihleri arasinda,Klinigimiz Endoskopi Ünitesi’nde, gastrointestinal sistem kanamasi nedeniyle, endoskopik inceleme yapilmis hastalarin dosyalari ve endoskopi raporlari geriye dönük olarak d egerlendirildi. Dieulafoy lezyonu tanisi dogrulanmis hastalarin demografik özellikleri, basvuru öncesi sikayetleri, yapilmis tetkik ve endoskopik islemlerin sonuçlari, endoskopik müdahalenin içerigi ve islem basarisi, islem sonrasi erken veya geç komplikasyon ya da yeniden kanama olup olmadigi analiz edildi. Bulgular: Toplam 48 hastaçalismaya alindi. Hastalarin 16’sinda lezyonun jejenumda bulundugu görüldü (%33.3). Mortalite hastalarin ikisinde (%4.2) gerçeklesti. En sik kullanilan endoskopik tedavi yöntemi kombine teknik olup (n=30), 29 hastada hemoklips tek basina veya kombinasyon tedavisi olarak uygulanmisti. On hastada, endoskopik müdahale sonrasi erken (n=6) veya geç (n=4) dönemde yeniden kanama gelisti. Kombine teknik uygulanan hastalarda, tek bir teknik uygulanan hastalara göre yeniden kanama oraninin daha düsük oldugu görüldü (p=0.027). Hemoklips içeren kombine tedaviler sadece hemoklips uygulamasiyla ya da argon plazma koagülasyon içeren kombine tedaviler sadece argon plazma koagülasyon uygulamasiyla karsilastirildiginda ise anlamli farklilik görülmedi (sirasiyla, p=0.300 ve p=0.550). Sonuç: Dieulafoy lezyonlari, standart endoskopik yöntemler kullanilarak kanama odagi tespit edilemeyen tüm hastalarda, ayirici tani seçenekleri arasinda bulunmali ve ince bagirsaklar, mutlaka olasi tutulum açisindan endoskopik olarak incelenmelidir. Mekanik ve termal yöntemleri içeren kombine uygulamalarin kullanilmasi yeniden kanama oranlarini azaltabilir.
Abstract
Background and Aims: The goal of this study was to determine the endoscopic treatments performed in patients diagnosed with Dieulafoy lesion in our clinic, the effectiveness and complication rates of these endoscopic treatments, and the rates of re-bleeding and hospitalization during the post-procedure follow-up period. Material and Methods: Files and endoscopy records of patients who underwent endoscopy at our clinic’s endoscopy unit due to gastrointestinal system bleeding were evaluated retrospectively between June 2015 and June 2020. Furthermore, demographic characteristics, complaints or examinations conducted for bleeding prior to application, and content and success of the endoscopic procedures, whether there are early or late complications or re-bleeding, were also analyzed in patients with established diagnoses of Dieulafoy lesion. Results: A total of 48 patients were included in the study. The lesion was observed in the jejunum of 16 patients(33.3%). Further, mortality occurred in two (4.2%) patients. The most widely used endoscopic treatment method was the combined technique (n = 30), and hemoclips were administered alone or as a combination therapy in 29 patients. In ten patients, re-bleeding occurred early (n = 6) or late (n = 4) period after endoscopic intervention. The rate of re-bleeding was found to be lower in patients who underwent the combined technique compared to patients who underwent a single technique (p = 0.027). There was no substantial difference (p = 0.300 and p = 0.550, respectively) when combined therapies containing hemoclips were compared either with hemoclip application or combined treatments containing argon plasma coagulation with only argon plasma coagulation application. Conclusion: Dieulafoy lesions should be among the differential diagnostic options for all patients whose bleeding focus cannot be identified using standard endoscopic methods, and the small intestines should be endoscopically examined for possible involvement . Moreover, the use of combined applications involving mechanical andthermal methods may reduce the rate of re-bleeding.
