S687 Efficacy of Endoscopic Treatment in Patients With Rectal Dieulafoy's Lesion: A Systematic Review
Bibliographic record
Abstract
Introduction: Dieulafoy’s lesion (DL) is an abnormally large, tortuous, submucosal vessel that erodes the overlying mucosa, without primary ulceration or erosion. Currently, up to 2% of these lesions are detected in the rectum. To our research, this is the first systematic review aiming to investigate the efficacy of endoscopic therapy in patients with rectal DL. Methods: A systematic search of MEDLINE, Cochrane, Embase, and Google Scholar databases was conducted for articles published between inception and June 20, 2021. The search terminologies included “Dieulafoy’s lesion,” “rectum,” “rectal DL,” “endoscopic treatment,” and “outcomes.” We also screened reference lists of search results and reviewed abstracts from major gastroenterology scientific meetings. Two authors meticulously reviewed all retrieved papers for patient data. The final inclusion criteria consisted of articles describing cases of rectal DL, with sufficient patient data available. Two authors independently reviewed each article for eligibility. The initial search yielded a total of 389 results. After exclusion, the final analysis included 84 studies. Results: A total of 113 case reports only (clinical evidence level: IV) met the inclusion criteria. The mean age of presentation was 67±14 years (range, 18–96 years), with 57% of cases reported in males. Major presentations included bright-red blood per rectum 48% and hematochezia 34%. Hypertension 33%, diabetes mellitus 23%, and chronic kidney disease 15% were among the common comorbidities. The average number of colonoscopies required for the diagnosis was 1.4±0.9. Endoscopic therapy was applied in 83% of patients, with a primary hemostasis rate of 88.17%. Endoscopic hemoclipping alone or in combination with epinephrine was among the preferred therapeutic techniques (Table 1). The overall mortality rate was 5.7%. Conclusion: Endoscopic therapy is safe and effective in rectal DL and can be considered the reference standard treatment. Patients can have a favorable clinical outcome if endoscopic therapy is applied early. Updated knowledge of the lesion and its clinical presentations can help early detection, leading to timely improvisation of endoscopic management, ultimately improving clinical outcomes. The long-term prognosis is excellent in patients treated with endoscopic methods. Future research should undertake stratification of the efficacy of commonly used endoscopic techniques to determine an optimal approach.Table 1.: Study Methodology Quality Assessment on Newcastle-Ottawa Scale.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.007 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".