Endoscopic Management and Follow Up of Dieulafoy Lesion in the Upper Gastrointestinal Tract

Background and Study Aims: Dieulafoy’s lesion is an important cause of upper gastrointestinal bleeding, and the safety and efficacy of endoscopic treatment have been widely accepted. The aim of this study was to evaluate the effectiveness of endoscopic management, including hemoclipping and injection methods, for bleeding Dieulafoy lesions in the upper gastrointestinal tract.
Patients and Methods: Between 1995 and 2003, 61 patients with bleeding Dieulafoy lesions underwent endoscopic treatment. The available hemostatic methods were hemoclipping, hypertonic saline-epinephrine injection, and pure ethanol injection. Clinical data, endoscopic features, and treatment outcome were analyzed retrospectively.
Results: Comorbid conditions were present in 39 patients (64 %). Active bleeding was noted in 20 patients (33 %). Hemoclipping was a selected treatment in 48 patients (79 %). Initial hemostasis was achieved in 61 patients (100 %). One patient had rebleeding 6 days after the initial procedure but was successfully treated endoscopically. The 30-day mortality was 0 %. During follow-up, for a mean of 47 months, 15 patients (25 %) died of causes unrelated to the Dieulafoy lesion. Two patients had recurrent bleeding due to non-Dieulafoy gastric ulcer, and responded to endoscopic therapy. We encountered no patients who required surgery.
Conclusions: Dieulafoy lesion can be successfully managed by endoscopic treatment. The long-term outcome is acceptable.

References

• 1 Juler G L, Labitzke H G, Lamb R, Allen R. The pathogenesis of Dieulafoy’s gastric erosion.  Am J Gastroenterol. 1984;  79 195-200
• 2 Anireddy D, Timberlake G, Seibert D. Dieulafoy’s lesion of the esophagus [letter].  Gastrointest Endosc. 1993;  39 604
• 3 Dy N M, Gostout C J, Balm R K. Bleeding from the endoscopically-identified Dieulafoy lesion of the proximal small intestine and colon.  Am J Gastroenterol. 1995;  90 108-111
• 4 Sone Y, Nakano S, Takeda I. et al . Massive hemorrhage from a Dieulafoy lesion in the cecum: successful endoscopic management.  Gastrointest Endosc. 2000;  51 510-512
• 5 Yeoh K G, Kang J Y. Dieulafoy’s lesion in the rectum.  Gastrointest Endosc. 1996;  43 614-616
• 6 Asaki S, Sato H, Nishimura T. et al . Endoscopic diagnosis and treatment of Dieulafoy’s ulcer.  Tohoku J Exp Med. 1988;  154 135-141
• 7 Pointner R, Schwab G, Königsrainer A, Dietze O. Endoscopic treatment of Dieulafoy’s disease.  Gastroenterology. 1988;  94 563-566
• 8 Stark M E, Gostout C J, Balm R K. Clinical features and endoscopic management of Dieulafoy’s disease.  Gastrointest Endosc. 1992;  38 545-550
• 9 Baettig B, Haecki W, Lammer F, Jost R. Dieulafoy’s disease: endoscopic treatment and follow up.  Gut. 1993;  34 1418-1421
• 10 Skok P. Endoscopic hemostasis in exulceratio simplex - Dieulafoy’s disease hemorrhage: a review of 25 cases.  Endoscopy. 1998;  30 590-594
• 11 Parra-Blanco A, Takahashi H, Jerez P VM. et al . Endoscopic management of Dieulafoy lesions of the stomach: a case study of 26 patients.  Endoscopy. 1997;  29 834-839
• 12 Chung I K, Kim E J, Lee M S. et al . Bleeding Dieulafoy’s lesions and the choice of endoscopic method: comparing the hemostatic efficacy of mechanical and injection methods.  Gastrointest Endosc. 2000;  52 721-724
• 13 Nikolaidis N, Zezos P, Giouleme O. et al . Endoscopic band ligation of Dielafoy-like lesions in the upper gastrointestinal tract.  Endoscopy. 2001;  33 754-760
• 14 Kasapidis P, Georgopoulos P, Delis V. et al . Endoscopic management and long-term follow-up of Dieulafoy’s lesions in the upper GI tract.  Gastrointest Endosc. 2002;  55 527-531
• 15 Park C H, Sohn Y H, Lee W S. et al . The usefulness of endoscopic hemoclipping for bleeding Dieulafoy lesions.  Endoscopy. 2003;  35 388-392
• 16 Yamaguchi Y, Yamato T, Katsumi N. et al . Short-term and long-term benefits of endoscopic hemoclip application for Dieulafoy’ s lesion in the upper GI tract.  Gastrointest Endosc. 2003;  57 653-656
• 17 Romãozinho J M, Pontes J M, Lérias C. et al . Dieulafoy’s lesion: management and long-term outcome.  Endoscopy. 2004;  36 416-420
• 18 Hirao M, Kobayashi T, Masuda K. et al . Endoscopic local injection of hypertonic saline-epinephrine solution to arrest hemorrhage from the upper gastrointestinal tract.  Gastrointest Endosc. 1985;  31 313-317
• 19 Asaki S, Nishimura T, Satoh A. et al . Endoscopic hemostasis of gastrointestinal hemorrhage by local application of absolute ethanol: a clinical study.  Tohoku J Exp Med. 1983;  141 373-383
• 20 Hachisu T. Evaluation of endoscopic hemostasis using an improved clipping apparatus.  Surg Endosc. 1988;  2 3-17
• 21 Sone Y, Nakano S. Endoscopic injection hemostasis combined with hemoclipping for bleeding peptic ulcer [abstract].  Dig Endosc. 1999;  11 271