An infrequent cause of upper gastrointestinal tract bleeding: "Dieulafoy's lesion"

Abstract

Background/aims: Dieulafoy's lesions are uncommon sources of upper gastrointestinal tract bleeding. Endoscopists must be aware of these lesions when evaluating patients with upper gastrointestinal tract bleeding.

Methodology: The aim of this study is to analyze the results of active bleeding or recurrently bleeding Dieulafoy's lesions treated either by endoscopic injection therapy (EIT) or endoscopic band ligation (EBL). Fifteen patients who had active bleeding due to Dieulafoy's lesions were evaluated retrospectively with respect to demographic properties, comorbidities, endoscopic therapy procedures, and the success rate of the procedure.

Results: The incidence of Dieulafoy's lesions was 4.5% in all cases of upper gastrointestinal tract bleeding. Among the 15 patients there were nine men and six women with a median age of 52 years (25-84 years). Eleven of these lesions were located in the stomach, two were in the duodenum, and two were in the distal esophagus. Eight patients were initially treated by EIT and seven patients had EBL therapy. There was no recurrent bleeding in any of the patients treated with EBL, but five patients (62.5%) treated with EIT bled again and were treated secondarily with EBL. Two of these patients required surgical intervention and one died on the 15th day of surgery due to myocardial infarction. No endoscopy-related complications were detected.

Conclusions: Endoscopic methods should be the first choice in treating bleeding Dieulafoy's lesions. Both EIT and EBL are successful methods for achieving initial hemostasis. However, EIT therapy has a higher re-bleeding rate. EBL is a safe and effective method for the treatment of bleeding Dieulafoy's lesions.