Dieulafoys Lesions

Figure 28-3 illustrates a gastric Dieulafoy lesion located on the lesser curvature. Permanent hemostasis was achieved with two hemoclips. Yamaguchi and colleagues (2003)prospectively examined the short and long term outcomes of HC application for primary hemostatic treatment of Dieulafoy's lesions. Of the 34 patients, 79.4% of the patients had active bleeding. Initial hemostasis was achieved with HC in 94.1% and the rate of recurrent bleeding was 9.3%. There was one death from unrelated causes and the remaining patients were followed for a mean of 53.8 months (range 19 to 90 months). Another Dieulafoy's lesion developed in one patient during follow-up, but in a different location compared with the index lesion.

Chung and colleagues (2000) divided 24 patients into mechanical (9 hemoclipping, 3 band ligation) and injection groups. The average number of endoscopic sessions needed to achieve permanent hemostasis for the mechanical and injection groups were 1.17 and 1.67, respectively. Initial hemostasis was achieved in 91.7% of patients undergoing mechanical therapy and 75% of those undergoing injection therapy, with none in the former group needing subsequent surgery in comparison to 17% of the latter group. The rate of recurrent bleeding in the mechanical therapy group was significantly lower in comparison to that of the injection therapy group (8.3% versus 33.3%, p < .05). Higher efficacy in terms of initial hemostasis and less recurrent bleeding was achieved by mechanical hemostatic therapy with hemoclip and band ligation compared with injection therapy.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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