Dieulafoy lesions of the GI tract: Localization and therapeutic outcomes

Luis F. Lara, Jayaprakash Sreenarasimhaiah, Shou Jiang Tang, Bianca B. Afonso, Don C. Rockey

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

Objectives: Dieulafoy lesions are a rare cause of gastrointestinal hemorrhage with a striking presentation because of rapid blood loss. Endoscopic therapy is usually successful at achieving primary hemostasis, but the best mode of endoscopic intervention is not clear, and outcomes relating to variables such as gender, medication, alcohol, and smoking are not known. We reviewed the clinical experience with Dieulafoy lesions at our institution, focusing on clinico-epidemiological features, management practices, and also survival. Methods: A retrospective and prospective cohort of patients with Dieulafoy lesions who underwent endoscopy from January 2004 through April 2009 were studied and detailed clinical data were abstracted and collected. Results: We identified 63 patients with a Dieulafoy lesion. The majority were male with an average age 58 years. Hematemesis and melena were the most common presenting symptoms. Almost half the patients were on anticoagulation medication. Most of the Dieulafoy lesions occurred in the upper GI tract, and mostly in the stomach. Single-modality endoscopic therapy was used as frequently as combination therapy, and both were effective, as primary hemostasis was achieved in 92% of cases. There were 11 deaths overall; death due to Dieulafoy lesion exsanguination was attributed to three patients. Conclusions: Dieulafoy lesions occurred in younger patients than previously reported, and were more frequently diagnosed in males. Most DL lesions occurred in the upper GI tract. Primary hemostasis with endoscopic therapy was highly successful. Overall mortality was 17%, and associated with co-morbidities, and not with medical history, gender, age, or medication.

Original languageEnglish (US)
Pages (from-to)3436-3441
Number of pages6
JournalDigestive Diseases and Sciences
Volume55
Issue number12
DOIs
StatePublished - Dec 1 2010

Keywords

  • Combination therapy
  • Dieulafoy lesion
  • Endoscopic therapy
  • Gastrointestinal bleeding
  • Hemoclips
  • Monotherapy
  • Mortality
  • Primary hemostasis
  • Secondary hemostasis

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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