Bleeding Dieulafoy's lesions and the choice of endoscopic method: comparing the hemostatic efficacy of mechanical and injection methods

Background: Dieulafoy's lesion has unique endoscopic and histopathologic ch aracteristics. This is a clinical trial of endoscopic therapy in 24 patient s with Dieulafoy's lesions. Methods: Patients were divided into 2 groups according to initial endoscopi c treatment method. Data were analyzed with respect to clinical and endosco pic characteristics as well as outcomes. The 24 patients were evenly divide d into mechanical (9 hemoclipping, 3 band ligation) and injection groups (1 2). Results: The average number of therapeutic endoscopic sessions needed to ac hieve permanent hemostasis for the mechanical and injection groups were 1.1 7 and 1.67, respectively. Initial hemostasis was achieved in 91.7% of patie nts undergoing mechanical therapy and 75% of those undergoing injection the rapy, with none in the former group needing subsequent surgery in compariso n to 17% of the latter group. The rate of recurrent bleeding in the mechani cal therapy group was significantly lower in comparison to the injection th erapy group (8.3% versus 33.3%, p < 0.05). Conclusions: Higher efficacy in terms of initial hemostasis and less recurr ent bleeding was achieved by mechanical hemostatic therapy with hemoclip an d band ligation compared with injection therapy. Endoscopic mechanical ther apy is recommended as effective for bleeding Dieulafoy's lesions.