Application Reseach Of Angiography Embolization And End-oscopy In The Diagnosis And Treatment Of Dieulafoy’s Lesion

ObjectiveTo evaluate the value,advantages and disadvantages on the diagnosis andtreatment of angiography embolization and endoscopy in Dieulafoy’s lesion.MethodsThe object of study was55cases of Dieulafoy’s lesion in our hospital from2003to2010,45male and10female,age54.2±10.4years old.All patients before treatmentwere evaluated,all who had not gastroscope contraindications firstly hadgastroscopy.If confirmed by gastroscope,they were allly used endoscopic epinephrineinjection method.If not confirmed by gastroscope or had gastroscopecontraindications,they had angiography.If confirmed by angiography,they directly hadvascular embolization. And those did too who had bleeding again after the secondendoscopic treatment. And those did too who had bleeding again after one vascularembolization. The results of two examination and therapeutic methods had beenStatistical analyzed.Results1. Diagnosis resultsThis group of55Dieulafoy’s lesions were confirmed by gastroscopy or/andangiography.92.7%(51/55) of them had gastroscopy examination,90.2%(46/51) ofthem had been diagnosed by gastroscopy.76.4%(42/55) of them had angiography examination,83.3%(35/42) of them had been diagnosed by angiography.The diagnosisaccordant rate of two examinations methods had no statistical difference with bychi-square test(P>0.05).2. Treatment results2.1Endoscopic therapy（46cases）: All of the46accordant Dieulafoy’s lesions bygastroscopy had endoscopic treatment.The endoscopic successful hemostasis rate was17.4%(8/46), unsuccessful hemostasis rate82.6%(38/46),2cases died and3caseshad surgical,the rest(33cases) had angiography embolization.13.0%(6/46)of themwere bleeding again in the first days after treatment,32.6%(15/46) in the second days.and37.0%(17/46) were bleeding again in later of the third days.Temporaryhemostasis rate of endoscopic injection sclerosis hemostasis was tall, and furtherbleeding rate did too.The further bleeding peak was in the second or third day.2.2Vascular embolization （42cases）：42cases had embolization in thisgroup,including33further bleeding cases after endoscopic therapy,4endoscopiccontraindications cases,5negative result cases by endoscopy.The embolism successfulhemostasis rate was95.0%(40/42), unsuccessful hemostasis rate5.0%(2/42),1casedied and1case had surgical.2.3Comparison of treatment results in two groups: The successful hemostasis rateof endoscopic therapy was17.4%(8/46) and the successful hemostasis rate of vascularembolization was95.0%(40/42).The successful hemostasis rate of those twotherapeutic methods had obvious statistical difference by chi-square test (P <0.01).Conclusion1. The diagnosis accordant rate of angiography and gastroscopy had no obviousdifference for Dieulafoy’s lesion.2. Embolization was better than endoscopic injection sclerosis hemostasis inhemostatic effect of Dieulafoy’s lesion.