Clin Endosc.  2015 Mar;48(2):112-120. 10.5946/ce.2015.48.2.112.

Endoscopic Management of Dieulafoy's Lesion

• Jeon HK
• Kim GH

• KMID: 1801201
• DOI: http://doi.org/10.5946/ce.2015.48.2.112

Abstract

A Dieulafoy's lesion is a vascular abnormality consisting of a large caliber-persistent tortuous submucosal artery. A small mucosal defect with the eruption of this protruding vessel can cause bleeding. In fact, a Dieulafoy's lesion is a relatively rare but potentially life-threatening condition. It accounts for 1% to 2% of cases of acute gastrointestinal bleeding. Although there is no consensus on the treatment of Dieulafoy's lesions; treatment options depend on the mode of presentation, site of the lesion, and available expertise. Endoscopic therapy is usually successful in achieving primary hemostasis, with hemostasis success rates reaching 75% to 100%. Although various therapeutic endoscopic methods are used to control bleeding in Dieulafoy's lesions, the best method for endoscopic intervention is not clear. Combination endoscopic therapy is known to be superior to monotherapy because of a lower rate of recurrent bleeding. In addition, mechanical therapies including hemostatic clipping and endoscopic band ligation are more effective and successful in controlling bleeding than other endoscopic methods. Advances in endoscopic techniques have reduced mortality in patients with Dieulafoy's lesion-from 80% to 8%-and consequently, the need for surgical intervention has been reduced. Currently, surgical intervention is used for cases that fail therapeutic endoscopic or angiographic interventions.

Keyword

Dieulafoy's lesion; Endoscopic treatment; Gastrointestinal tract

MeSH Terms

Arteries
Consensus
Gastrointestinal Tract
Hemorrhage
Hemostasis
Humans
Ligation
Mortality

Figure

• 

  Fig. 1 Endoscopic findings of Dieulafoy's lesions in the gastrointestinal tract. Protruding vessel with active bleeding within a minute mucosal defect and normal surrounding mucosa is visualized in the stomach (A) and jejunum (B).

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  Fig. 2 Angiographic findings of Dieulafoy's lesions in the gastrointestinal tract. Angiographic intervention was performed after unsuccessful endoscopic treatment (hemostatic clip application) of a bleeding Dieulafoy's lesion on the upper body of the stomach. (A) There is an extravasation of contrast from a branch of the left gastric artery. (B) Gel-foam embolization was performed. (C) Extravasation of contrast was no longer seen on angiography.

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  Fig. 3 Endoscopic hemostatic clip application to Dieulafoy's lesions in the stomach (A, B) and colon (C, D).

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  Fig. 4 Endoscopic band ligation to a Dieulafoy's lesion just below the gastroesophageal junction (A, B).

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  Fig. 5 Combination therapy consists of epinephrine injection therapy followed by hemostatic clipping of Dieulafoy's lesions in the stomach (A-C) and the jejunum (D-F).

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