Annals of medicine · 2025
Forrest-type IIb increases the risk of rebleeding after endoscopic treatment in patients with Dieulafoy's lesion of the upper gastrointestinal tract.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Qiu Jiayu, Xia Yanhong, Ouyang Qingping, Wang Liping, Ding Ruiying, Huang Yang, Yang Zhenzhen, Shu Xu, Pan Xiaolin, Zhang Yanxia
Аннотация
BACKGROUND: Dieulafoy's lesion (DL) is a rare cause of nonvariceal upper gastrointestinal bleeding (NVUGIB) and represents a significant clinical challenge. This research aimed to identify the potential risk factors contributing to DL rebleeding after endoscopic hemostasis, including patient characteristics and laboratory and endoscopic findings such as the Forrest classification.
METHODS: This retrospective study encompassed patients diagnosed with upper gastrointestinal DL who received standard endoscopic hemostasis between April 2007 and June 2024. Patients included in this study were categorized into the rebleeding and non-rebleeding groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for DL rebleeding.
RESULTS: Of the 272 patients included in this study, rebleeding occurred in 46 (16.9%). Multivariate logistic regression demonstrated that Forrest-type IIb lesions (odds ratio [OR] 3.86, 95% confidence intervals [CI] 1.16-12.83, p = 0.027) and less experienced endoscopists (OR 3.74, 95%CI 1.82-7.66, p < 0.001) were recognized as independent risk factors for rebleeding of DL in the upper gastrointestinal tract after endoscopic hemostasis. Compared with the non-rebleeding group, patients in the rebleeding group had received more transfusion units, a longer length of hospitalization, and higher rates of intensive care unit (ICU) transfer, embolization or surgery, and mortality (p < 0.005).
CONCLUSION: Forrest-type IIb lesions and less experienced endoscopists were independent risk factors for DL rebleeding in the upper gastrointestinal tract after endoscopic hemostasis. More attention should be given to DL presenting as Forrest-type IIb, as rebleeding is often closely associated with a worse clinical prognosis.
METHODS: This retrospective study encompassed patients diagnosed with upper gastrointestinal DL who received standard endoscopic hemostasis between April 2007 and June 2024. Patients included in this study were categorized into the rebleeding and non-rebleeding groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for DL rebleeding.
RESULTS: Of the 272 patients included in this study, rebleeding occurred in 46 (16.9%). Multivariate logistic regression demonstrated that Forrest-type IIb lesions (odds ratio [OR] 3.86, 95% confidence intervals [CI] 1.16-12.83, p = 0.027) and less experienced endoscopists (OR 3.74, 95%CI 1.82-7.66, p < 0.001) were recognized as independent risk factors for rebleeding of DL in the upper gastrointestinal tract after endoscopic hemostasis. Compared with the non-rebleeding group, patients in the rebleeding group had received more transfusion units, a longer length of hospitalization, and higher rates of intensive care unit (ICU) transfer, embolization or surgery, and mortality (p < 0.005).
CONCLUSION: Forrest-type IIb lesions and less experienced endoscopists were independent risk factors for DL rebleeding in the upper gastrointestinal tract after endoscopic hemostasis. More attention should be given to DL presenting as Forrest-type IIb, as rebleeding is often closely associated with a worse clinical prognosis.