Analysis of the efficacy and safety of balloon-assisted enteroscopy for the diagnosis and treatment of Dieulafoy lesions of the small intestine (with video)
10.3760/cma.j.cn321463-20250124-00306
- VernacularTitle:气囊辅助小肠镜诊治小肠Dieulafoy病变的效果和安全性初步分析（含视频）
- Author:
Donglin ZHAO
1
;
Mengnan XU
;
Zhimeng JIANG
;
Jing ZHANG
;
Yan YU
;
Nianjun XIAO
;
Bairong LI
;
Chongxi FAN
;
Shoubin NING
;
Tao SUN
Author Information
1. 河北北方学院研究生院，张家口 075000
- Publication Type:Journal Article
- Keywords:
Intestine, small;
Dieulafoy lesion;
Balloon-assisted enteroscopy
- From:
Chinese Journal of Digestive Endoscopy
2025;42(11):881-886
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the incidence, clinical features, factors affecting initial diagnosis, efficacy, and safety of therapy and prognosis of small intestinal Dieulafoy lesions (DL).Methods:Clinical data including clinical background, diagnosis, and treatment details of patients who were admitted to the Department of Gastroenterology, Air Force Medical Center, for suspected small bowel bleeding, diagnosed as having small bowel DL and treated with balloon-assisted enteroscopy (BAE) were retrospectively analyzed from November 2017 to March 2024.Results:Among 800 patients, 30 cases (3.75%, 30/800, 17 males and 13 females) were diagnosed as having small intestine DL with the mean age of 60.90 years. Clinical symptoms included melena (56.67%, 17/30), hematochezia (43.33%, 13/30), and hemodynamic instability (30.00%, 9/30). Active bleeding occurred in 23 (76.67%) patients. Comorbidities existed in 70.00% (21/30) and 33.33% (10/30) used long-term antithrombotic agents. Diagnosis was confirmed after a single BAE in 63.33% (19/30) and after multiple BAEs (mean 1.6 procedures) in 36.67% (11/30). Lesions were predominantly located at jejunal. All patients achieved successful treatment with a single BAE procedure. The median follow-up period was 12.25 months (range: 5.25-23.00 months). Five cases (16.67%) experienced recurrent bleeding, with one case transfered to surgical intervention. Two cases (6.67%) reported post-operative symptoms of dizziness and fatigue, which resolved after symptomatic management. Multivariate analysis showed that long-term oral anticoagulant therapy ( OR=0.06, 95% CI: 0.01-0.73) was an independent predictor of single-session diagnosis. Conclusion:Small intestinal DL is rare and challenging to diagnose. Antithrombotic therapy may facilitate the diagnosis of DL at the first BAE. Jejunal localization is common, and combined endoscopic therapy (including clipping) is effective and safe.
