Mechanical Versus Injection Endoscopic Therapy for Dieulafoy's Lesion: a Systematic Review and Meta-Analysis

Area of Science:

• Gastroenterology
• Endoscopic interventions
• Gastrointestinal bleeding

Background:

• Dieulafoy's lesion is a rare, life-threatening gastrointestinal condition.
• Optimal endoscopic management strategies remain debated.
• This meta-analysis evaluates mechanical versus injection endoscopic interventions.

Purpose of the Study:

• To compare the efficacy and safety of endoscopic mechanical interventions and endoscopic injection interventions for Dieulafoy's lesion.
• To determine the preferred endoscopic approach for managing Dieulafoy's lesion.

Main Methods:

• Systematic literature search of PubMed, Google Scholar, and Cochrane Library up to March 2023.
• Included seven comparative studies (3 trials, 4 retrospective).
• Analyzed initial hemostasis, recurrent bleeding, death, and need for operation using odds ratios and confidence intervals.

Main Results:

• Endoscopic injection therapy significantly reduced the risk of recurrent bleeding (OR=0.33 [0.16, 0.69], p=0.003).
• No significant differences were observed in initial hemostasis, mortality, or operative rates between mechanical and injection techniques.

Conclusions:

• Injection methods may be preferable for Dieulafoy's lesion management due to reduced recurrent bleeding.
• Further research is needed to confirm findings and assess long-term outcomes.