Dieulafoy's lesion: a case series study

Abstract

Aim: Dieulafoy's lesion (DL) accounts for 1-5.8% of cases of acute upper gastrointestinal bleeding (GIB). Its mortality is high, approaching 20%, despite recent advances in endoscopic therapy. We aimed to report our experience in the treatment of DL.

Methods: A retrospective case study of all patients with DL between January 1993 and January 2003 was done. Characteristics, treatment methods, success rates and 30-d mortality of the patients were analyzed.

Results: Thirty-six patients were noted to have DL in the study period. Thirty-three records were available for assessment in which 35 DL were identified. The median age of the patients was 67 years with male to female ratio of 5.6:1. Significant comorbidities existed in 69% of the patients. Eighty-nine percent of the DL was found at first endoscopy, three DL at laparotomy. Significant coexistent endoscopic findings existed in 23%. Hemostasis was achieved in 88% by using adrenaline injection, or in combination with heater probe application at first endoscopy. Four cases had re-bleeding, all were successfully treated endoscopically. The 30-d mortality rate was 23%.

Conclusion: Successful endoscopic hemostasis could be achieved in 100% of cases of DL. The overall mortality may still remain high, mainly due to the comorbidities and age of these patients.

Figure 1

Distribution of the positions of the DLs. The number of cases in each group is given in brackets. D1, first part of duodenum; D2, second part of duodenum.

Figure 2

Therapy-induced uncontrolled bleeding of a DL and subsequent successful treatment with hemoclips. A: large DL inside a peri-ampullary diverticulum; B: adrenaline injection and heat probe therapy-induced uncontrolled bleeding; C: the bleeding was finally controlled with hemoclip application.