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Review
. 2010 Oct;92(7):548-54.
doi: 10.1308/003588410X12699663905311.

Dieulafoy's lesion: current trends in diagnosis and management

M Baxter  1 , E H Aly
Affiliations
Review

Dieulafoy's lesion: current trends in diagnosis and management

M Baxter et al. Ann R Coll Surg Engl. 2010 Oct.

Abstract

Background: Dieulafoy's lesion is a relatively rare, but potentially life-threatening, condition. It accounts for 1-2% of acute gastrointestinal (GI) bleeding, but arguably is under-recognised rather than rare. Its serious nature makes it necessary to include it in the differential diagnosis of obscure GI bleeding. The aim of this study was to review the current trends in the diagnosis and management of Dieulafoy's lesion.

Materials and methods: Using Medline, a literature search was performed for articles published in English, using the search words 'Dieulafoy'(s)' and 'gastrointestinal bleeding'. All retrieved papers were analysed and the findings are summarised in this review.

Results: There is no consensus on the treatment of Dieulafoy's lesions. Therapeutic endoscopy can control the bleeding in 90% of patients while angiography is being accepted as a valuable alternative to endoscopy for inaccessible lesions. Currently, surgical intervention is kept for failure of therapeutic endoscopic or angiographic interventions and it should be guided by pre-operative localisation.

Conclusions: Advances in endoscopy have increased the detection of Dieulafoy's lesions and decreased the mortality from 80% to 8.6%. There are recent encouraging reports on the successful use of laparoscopic surgery in managing symptomatic Dieulafoy's lesions.

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Figures

None
Georges Dieulafoy (1839–1911) The picture is considered to be in the public domain from the National Library of Medicine <http://ihm.nlm.mih.gov)>
Figure 1
Figure 1
Location of Dieulafoy's lesion reported in literature.
Figure 2
Figure 2
Mean percentage of the location of Dieulafoy's lesion.,,,,,,
Figure 3
Figure 3
Presentation of Dieulafoy's lesion.
Figure 4
Figure 4
Mean percentage of the presentation of Dieulafoy's lesion.
Figure 5
Figure 5
Treatment algorithm for Dieulafoy's lesion.
See this image and copyright information in PMC

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