Dieulafoy's Disease of Upper Gastrointestinal Tract: Clinical Features and Endoscopic Treatment

Park, Soo Jin; Yoo, Hyo Min; Kim, Hyung Gil; Lee, Yong Chan; Moon, Young Myung; Kang, Jin Kyung; Park, In Suh

Abstract

BACKGROUND AND AIMS
Dieulafoy' s disease is an uncommon cause of recurrent massive gastrointestinal bleeding. The bleeding results from abnormally large submucosal artery , usually located on proximal stomach. Endoscopic examination reveals a small mucosal defect with an isolated protruding vessel without associated ulcer. Endoscopic treatment had recently been attempted to control the bleeding from these lesions. METHODS: The clinical and endoscopic characteristics of 51 patients with gastrointestinal bleeding due to Dieulafoy' s disease were retrospectively analysed from January 1991 to July 1997 and the efficacy of endoscopic therapy of Dieulafoy' s disease was evaluated. RESULTS: The mean age was 51.2 +/-16.2 (Mean +/-SD, range: 19-80) years and male predominance (4.7 : 1) was observed. Symptoms included: melena (45.1%); hematochezia (31.4%); melena and hematochezia (23.5%). The mean hemoglobin value was 7.5 +/-2.1 g/dL. The mean transfusion requirement was 12.4 +/-13.2 blood units. The diagnosis was made at initial endoscopy in 72.5%. The lesion located in proximal stomach (49.0%), in mid/distal stomach (25.5%) and in duodenum (25.5%) in order. Endoscopic therapies included fibrin glue injection (FG) in 16 patients, hypertonic saline-epinephrine (1 : 1,000) injection (HSE) in 15 patients, HSE+FG in 14 patients and others in 6 patients. Overall, endo-scopic trreatment was successful in achieving hemostasis in 38 (74.5%) patients; FG in 14/16 (87.6%), HSE in 12/15 (80.0%), FG HSE in 9/14 (64.3%). There was no significant difference in success rate among the endoscopic treatment modalities. Nine patients had to be operated despite the endoscopic treatments, and four patients died due to the causes other than gastrointestinal bleeding. CONCLUSIONS: Endoscopic therapy of upper gastrointestinal Dieulafoy' s disease is effective and should be employed before the surgical intervention.