Endoscopic Band Ligation in Bleeding Dieulafoy's Lesions

Yoo, Kwon; Moon, Jeong Seop; Kim, Hee Sook; Jeon, Young Bin; Park, Jae Sun

Abstract

BACKGROUND AND AIMS
The Dieulafoy's lesion is an unusual cause of massive gastrointestinal bleeding resulting from the erosion of an abnormally large submucosal artery. Surgical intervention was believed to be the best treatment in the past, but recently improvement of endoscopic techniques has made effective hemostasis possible in most cases of Dieulafoy's lesions. Therapeutic endoscopic hemostasis includes sclerotherapy, electrocauterization, laser coagulotherapy, clipping band ligation. The effectiveness of the endoscopic band ligation was evaluated in bleeding Dieulafoy's lesions.
METHODS
Clinical characteristics, initial endoscopic findings, and effectiveness of band ligation in Dieulafoy's lesions were all analyzed.
RESULTS
1) The patients were 8 males and 1 female, and the mean age was 56.2 years. 2) The chief complaints were melena and hematemesis, and 2 cases had histories of recurrent gastrointestinal bleeding. 3) The diagnosis of Dieulafoy's lesion was possible in 7 of 9 patients (78%) at the initial endoscopy. 4) The lesions were mostly located in the fundus and the body, characterized mainly by protruding vessels in shallow erosion areas. 5) The initial band ligation was possible with successful hemostasis, but additional sclerotherapy was necessary in two cases. There were no complications related to the procedure, except a case of early band detachment.
CONCLUSIONS
The Dieulafoy's lesion requires careful endoscopic observation for diagnosis, and endoscopic band ligation was an effective therapeutic option for bleeding Dieulafoy's lesions.