Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding
Background and Aim Although Dieulafoy's lesion (DL) is an important cause of nonvariceal upper gastrointestinal (GI) bleeding, few studies have investigated the clinico‐epidemiological outcomes due to its rarity. Here, we investigated clinical features of upper GI bleeding caused by peptic ulce...
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| Veröffentlicht in: | Journal of gastroenterology and hepatology 2023-06, Vol.38 (6), p.888-895 |
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| creator | Jo, Sang Yong Noh, Jin Hee Cha, Boram Ahn, Ji Yong Oh, Seung‐pyo Seo, Jun‐young Na, Hee Kyong Lee, Jeong Hoon Jung, Kee Wook Kim, Do Hoon Choi, Kee Don Song, Ho June Lee, Gin Hyug Jung, Hwoon‐Yong |
| description | Background and Aim
Although Dieulafoy's lesion (DL) is an important cause of nonvariceal upper gastrointestinal (GI) bleeding, few studies have investigated the clinico‐epidemiological outcomes due to its rarity. Here, we investigated clinical features of upper GI bleeding caused by peptic ulcer (PU) or DL and compared endoscopic treatment outcomes.
Methods
Patients with upper GI bleeding resulting from PU or DL who visited emergency room between January 2013 and December 2017 were eligible. Clinical features and treatment outcomes were retrospectively investigated.
Results
Overall, 728 patients with upper GI bleeding due to PU (n = 669) and DL (n = 59) were enrolled. The median age was 64 years (interquartile range [IQR], 56–75 years), and 74.3% were male. Endoscopic intervention was performed in 53.7% (n = 359) and 98.3% (n = 58) of the PU and DL groups, respectively (P |
| doi_str_mv | 10.1111/jgh.16139 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2773719667</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2825940114</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3539-78c6b0bac5b0229214f1ca5c7b64077277e4929374dec44f910590053ad33ce93</originalsourceid><addsrcrecordid>eNp1kE1LAzEQhoMotn4c_AMS8KAetk022U1zlKpVKXjR85LNzrYp6WZNdin990ZbPQjOZQbm4eHlReiCkhGNM14tliOaUyYP0JByThIqeH6IhmRCs0QyKgfoJIQVIYQTkR2jAcsFJ5JPhgim1jRGK4td32m3hoBdje8N9FbVbnsdsIVgXIPjr1UeKrwx3RK30HZG495q8Ng0uG_beCxU6LwzTQehM010lhagMs3iDB3VygY43-9T9P748DZ9Suavs-fp3TzRLGMyEROdl6RUOitJmsqU8ppqlWlR5jG4SIUALlPJBK9Ac15LSjJJSMZUxZgGyU7Rzc7bevfRxxTF2gQN1qoGXB-KaGCCyjwXEb36g65c72PoSE3STHJCKY_U7Y7S3oXgoS5ab9bKbwtKiq_ui9h98d19ZC_3xr5cQ_VL_pQdgfEO2BgL2_9Nxcvsaaf8BPsojT8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2825940114</pqid></control><display><type>article</type><title>Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Jo, Sang Yong ; Noh, Jin Hee ; Cha, Boram ; Ahn, Ji Yong ; Oh, Seung‐pyo ; Seo, Jun‐young ; Na, Hee Kyong ; Lee, Jeong Hoon ; Jung, Kee Wook ; Kim, Do Hoon ; Choi, Kee Don ; Song, Ho June ; Lee, Gin Hyug ; Jung, Hwoon‐Yong</creator><creatorcontrib>Jo, Sang Yong ; Noh, Jin Hee ; Cha, Boram ; Ahn, Ji Yong ; Oh, Seung‐pyo ; Seo, Jun‐young ; Na, Hee Kyong ; Lee, Jeong Hoon ; Jung, Kee Wook ; Kim, Do Hoon ; Choi, Kee Don ; Song, Ho June ; Lee, Gin Hyug ; Jung, Hwoon‐Yong</creatorcontrib><description>Background and Aim
Although Dieulafoy's lesion (DL) is an important cause of nonvariceal upper gastrointestinal (GI) bleeding, few studies have investigated the clinico‐epidemiological outcomes due to its rarity. Here, we investigated clinical features of upper GI bleeding caused by peptic ulcer (PU) or DL and compared endoscopic treatment outcomes.
Methods
Patients with upper GI bleeding resulting from PU or DL who visited emergency room between January 2013 and December 2017 were eligible. Clinical features and treatment outcomes were retrospectively investigated.
Results
Overall, 728 patients with upper GI bleeding due to PU (n = 669) and DL (n = 59) were enrolled. The median age was 64 years (interquartile range [IQR], 56–75 years), and 74.3% were male. Endoscopic intervention was performed in 53.7% (n = 359) and 98.3% (n = 58) of the PU and DL groups, respectively (P < 0.0001). Patients were matched by sex, age, body mass index, comorbidity, and past medical history, and 190 PU and 52 DL were finally selected. The rebleeding rates within 7 (7.37% vs 17.31%, P = 0.037) and 30 (7.37% vs 26.92%, P < 0.001) days after initial endoscopy were significantly lower in the PU than in the DL group after propensity score matching. During the median follow‐up period of 52 months (IQR, 34–70 months), there was no difference in overall survival rate (67.9% vs 82.7%, P = 0.518).
Conclusions
Although DL is a rare cause of upper GI bleeding, it requires endoscopic hemostasis more frequently and has a higher rate of rebleeding than PU even after therapeutic endoscopy. Endoscopists should pay attention and perform active endoscopic hemostasis for DL bleeding.</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/jgh.16139</identifier><identifier>PMID: 36740948</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Aged ; Bleeding ; Body mass index ; Clinical outcomes ; Comorbidity ; Dieulafoy's lesion ; Emergency medical care ; Endoscopy ; Endoscopy, Gastrointestinal - adverse effects ; Epidemiology ; Female ; Gastrointestinal Hemorrhage - etiology ; Gastrointestinal Hemorrhage - therapy ; Hemostasis ; Hemostasis, Endoscopic - adverse effects ; Humans ; Male ; Middle Aged ; Patients ; peptic ulcer ; Peptic Ulcer - complications ; Peptic ulcers ; rebleeding ; Retrospective Studies ; Ulcers ; upper gastrointestinal bleeding</subject><ispartof>Journal of gastroenterology and hepatology, 2023-06, Vol.38 (6), p.888-895</ispartof><rights>2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.</rights><rights>2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-78c6b0bac5b0229214f1ca5c7b64077277e4929374dec44f910590053ad33ce93</citedby><cites>FETCH-LOGICAL-c3539-78c6b0bac5b0229214f1ca5c7b64077277e4929374dec44f910590053ad33ce93</cites><orcidid>0000-0001-6720-9528 ; 0000-0001-6764-9099 ; 0000-0002-3771-3691 ; 0000-0002-0030-3744 ; 0000-0002-3195-8794 ; 0000-0002-4250-4683 ; 0000-0003-1281-5859</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgh.16139$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgh.16139$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36740948$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jo, Sang Yong</creatorcontrib><creatorcontrib>Noh, Jin Hee</creatorcontrib><creatorcontrib>Cha, Boram</creatorcontrib><creatorcontrib>Ahn, Ji Yong</creatorcontrib><creatorcontrib>Oh, Seung‐pyo</creatorcontrib><creatorcontrib>Seo, Jun‐young</creatorcontrib><creatorcontrib>Na, Hee Kyong</creatorcontrib><creatorcontrib>Lee, Jeong Hoon</creatorcontrib><creatorcontrib>Jung, Kee Wook</creatorcontrib><creatorcontrib>Kim, Do Hoon</creatorcontrib><creatorcontrib>Choi, Kee Don</creatorcontrib><creatorcontrib>Song, Ho June</creatorcontrib><creatorcontrib>Lee, Gin Hyug</creatorcontrib><creatorcontrib>Jung, Hwoon‐Yong</creatorcontrib><title>Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>Background and Aim
Although Dieulafoy's lesion (DL) is an important cause of nonvariceal upper gastrointestinal (GI) bleeding, few studies have investigated the clinico‐epidemiological outcomes due to its rarity. Here, we investigated clinical features of upper GI bleeding caused by peptic ulcer (PU) or DL and compared endoscopic treatment outcomes.
Methods
Patients with upper GI bleeding resulting from PU or DL who visited emergency room between January 2013 and December 2017 were eligible. Clinical features and treatment outcomes were retrospectively investigated.
Results
Overall, 728 patients with upper GI bleeding due to PU (n = 669) and DL (n = 59) were enrolled. The median age was 64 years (interquartile range [IQR], 56–75 years), and 74.3% were male. Endoscopic intervention was performed in 53.7% (n = 359) and 98.3% (n = 58) of the PU and DL groups, respectively (P < 0.0001). Patients were matched by sex, age, body mass index, comorbidity, and past medical history, and 190 PU and 52 DL were finally selected. The rebleeding rates within 7 (7.37% vs 17.31%, P = 0.037) and 30 (7.37% vs 26.92%, P < 0.001) days after initial endoscopy were significantly lower in the PU than in the DL group after propensity score matching. During the median follow‐up period of 52 months (IQR, 34–70 months), there was no difference in overall survival rate (67.9% vs 82.7%, P = 0.518).
Conclusions
Although DL is a rare cause of upper GI bleeding, it requires endoscopic hemostasis more frequently and has a higher rate of rebleeding than PU even after therapeutic endoscopy. Endoscopists should pay attention and perform active endoscopic hemostasis for DL bleeding.</description><subject>Aged</subject><subject>Bleeding</subject><subject>Body mass index</subject><subject>Clinical outcomes</subject><subject>Comorbidity</subject><subject>Dieulafoy's lesion</subject><subject>Emergency medical care</subject><subject>Endoscopy</subject><subject>Endoscopy, Gastrointestinal - adverse effects</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Gastrointestinal Hemorrhage - therapy</subject><subject>Hemostasis</subject><subject>Hemostasis, Endoscopic - adverse effects</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>peptic ulcer</subject><subject>Peptic Ulcer - complications</subject><subject>Peptic ulcers</subject><subject>rebleeding</subject><subject>Retrospective Studies</subject><subject>Ulcers</subject><subject>upper gastrointestinal bleeding</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LAzEQhoMotn4c_AMS8KAetk022U1zlKpVKXjR85LNzrYp6WZNdin990ZbPQjOZQbm4eHlReiCkhGNM14tliOaUyYP0JByThIqeH6IhmRCs0QyKgfoJIQVIYQTkR2jAcsFJ5JPhgim1jRGK4td32m3hoBdje8N9FbVbnsdsIVgXIPjr1UeKrwx3RK30HZG495q8Ng0uG_beCxU6LwzTQehM010lhagMs3iDB3VygY43-9T9P748DZ9Suavs-fp3TzRLGMyEROdl6RUOitJmsqU8ppqlWlR5jG4SIUALlPJBK9Ac15LSjJJSMZUxZgGyU7Rzc7bevfRxxTF2gQN1qoGXB-KaGCCyjwXEb36g65c72PoSE3STHJCKY_U7Y7S3oXgoS5ab9bKbwtKiq_ui9h98d19ZC_3xr5cQ_VL_pQdgfEO2BgL2_9Nxcvsaaf8BPsojT8</recordid><startdate>202306</startdate><enddate>202306</enddate><creator>Jo, Sang Yong</creator><creator>Noh, Jin Hee</creator><creator>Cha, Boram</creator><creator>Ahn, Ji Yong</creator><creator>Oh, Seung‐pyo</creator><creator>Seo, Jun‐young</creator><creator>Na, Hee Kyong</creator><creator>Lee, Jeong Hoon</creator><creator>Jung, Kee Wook</creator><creator>Kim, Do Hoon</creator><creator>Choi, Kee Don</creator><creator>Song, Ho June</creator><creator>Lee, Gin Hyug</creator><creator>Jung, Hwoon‐Yong</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6720-9528</orcidid><orcidid>https://orcid.org/0000-0001-6764-9099</orcidid><orcidid>https://orcid.org/0000-0002-3771-3691</orcidid><orcidid>https://orcid.org/0000-0002-0030-3744</orcidid><orcidid>https://orcid.org/0000-0002-3195-8794</orcidid><orcidid>https://orcid.org/0000-0002-4250-4683</orcidid><orcidid>https://orcid.org/0000-0003-1281-5859</orcidid></search><sort><creationdate>202306</creationdate><title>Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding</title><author>Jo, Sang Yong ; Noh, Jin Hee ; Cha, Boram ; Ahn, Ji Yong ; Oh, Seung‐pyo ; Seo, Jun‐young ; Na, Hee Kyong ; Lee, Jeong Hoon ; Jung, Kee Wook ; Kim, Do Hoon ; Choi, Kee Don ; Song, Ho June ; Lee, Gin Hyug ; Jung, Hwoon‐Yong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-78c6b0bac5b0229214f1ca5c7b64077277e4929374dec44f910590053ad33ce93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Bleeding</topic><topic>Body mass index</topic><topic>Clinical outcomes</topic><topic>Comorbidity</topic><topic>Dieulafoy's lesion</topic><topic>Emergency medical care</topic><topic>Endoscopy</topic><topic>Endoscopy, Gastrointestinal - adverse effects</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Gastrointestinal Hemorrhage - therapy</topic><topic>Hemostasis</topic><topic>Hemostasis, Endoscopic - adverse effects</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>peptic ulcer</topic><topic>Peptic Ulcer - complications</topic><topic>Peptic ulcers</topic><topic>rebleeding</topic><topic>Retrospective Studies</topic><topic>Ulcers</topic><topic>upper gastrointestinal bleeding</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jo, Sang Yong</creatorcontrib><creatorcontrib>Noh, Jin Hee</creatorcontrib><creatorcontrib>Cha, Boram</creatorcontrib><creatorcontrib>Ahn, Ji Yong</creatorcontrib><creatorcontrib>Oh, Seung‐pyo</creatorcontrib><creatorcontrib>Seo, Jun‐young</creatorcontrib><creatorcontrib>Na, Hee Kyong</creatorcontrib><creatorcontrib>Lee, Jeong Hoon</creatorcontrib><creatorcontrib>Jung, Kee Wook</creatorcontrib><creatorcontrib>Kim, Do Hoon</creatorcontrib><creatorcontrib>Choi, Kee Don</creatorcontrib><creatorcontrib>Song, Ho June</creatorcontrib><creatorcontrib>Lee, Gin Hyug</creatorcontrib><creatorcontrib>Jung, Hwoon‐Yong</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jo, Sang Yong</au><au>Noh, Jin Hee</au><au>Cha, Boram</au><au>Ahn, Ji Yong</au><au>Oh, Seung‐pyo</au><au>Seo, Jun‐young</au><au>Na, Hee Kyong</au><au>Lee, Jeong Hoon</au><au>Jung, Kee Wook</au><au>Kim, Do Hoon</au><au>Choi, Kee Don</au><au>Song, Ho June</au><au>Lee, Gin Hyug</au><au>Jung, Hwoon‐Yong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2023-06</date><risdate>2023</risdate><volume>38</volume><issue>6</issue><spage>888</spage><epage>895</epage><pages>888-895</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>Background and Aim
Although Dieulafoy's lesion (DL) is an important cause of nonvariceal upper gastrointestinal (GI) bleeding, few studies have investigated the clinico‐epidemiological outcomes due to its rarity. Here, we investigated clinical features of upper GI bleeding caused by peptic ulcer (PU) or DL and compared endoscopic treatment outcomes.
Methods
Patients with upper GI bleeding resulting from PU or DL who visited emergency room between January 2013 and December 2017 were eligible. Clinical features and treatment outcomes were retrospectively investigated.
Results
Overall, 728 patients with upper GI bleeding due to PU (n = 669) and DL (n = 59) were enrolled. The median age was 64 years (interquartile range [IQR], 56–75 years), and 74.3% were male. Endoscopic intervention was performed in 53.7% (n = 359) and 98.3% (n = 58) of the PU and DL groups, respectively (P < 0.0001). Patients were matched by sex, age, body mass index, comorbidity, and past medical history, and 190 PU and 52 DL were finally selected. The rebleeding rates within 7 (7.37% vs 17.31%, P = 0.037) and 30 (7.37% vs 26.92%, P < 0.001) days after initial endoscopy were significantly lower in the PU than in the DL group after propensity score matching. During the median follow‐up period of 52 months (IQR, 34–70 months), there was no difference in overall survival rate (67.9% vs 82.7%, P = 0.518).
Conclusions
Although DL is a rare cause of upper GI bleeding, it requires endoscopic hemostasis more frequently and has a higher rate of rebleeding than PU even after therapeutic endoscopy. Endoscopists should pay attention and perform active endoscopic hemostasis for DL bleeding.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36740948</pmid><doi>10.1111/jgh.16139</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-6720-9528</orcidid><orcidid>https://orcid.org/0000-0001-6764-9099</orcidid><orcidid>https://orcid.org/0000-0002-3771-3691</orcidid><orcidid>https://orcid.org/0000-0002-0030-3744</orcidid><orcidid>https://orcid.org/0000-0002-3195-8794</orcidid><orcidid>https://orcid.org/0000-0002-4250-4683</orcidid><orcidid>https://orcid.org/0000-0003-1281-5859</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Bleeding Body mass index Clinical outcomes Comorbidity Dieulafoy's lesion Emergency medical care Endoscopy Endoscopy, Gastrointestinal - adverse effects Epidemiology Female Gastrointestinal Hemorrhage - etiology Gastrointestinal Hemorrhage - therapy Hemostasis Hemostasis, Endoscopic - adverse effects Humans Male Middle Aged Patients peptic ulcer Peptic Ulcer - complications Peptic ulcers rebleeding Retrospective Studies Ulcers upper gastrointestinal bleeding |
| title | Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding |
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