Management and long-term prognosis of Dieulafoy lesion

I. D. Norton, B. T. Petersen, D. Sorbi, R. K. Balm, G. L. Alexander, C. J. Gostout

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160 Scopus citations

Abstract

Background: The Dieulafoy lesion is an important cause of gastrointestinal (GI) hemorrhage. Optimal treatment and long-term outcome are unknown. This study aimed to characterize the presentation of the Dieulafoy lesion and to summarize the results and report the long-term outcome of endoscopic therapy. Methods: Data regarding diagnosis, treatment and outcomes were derived from our GI Bleed Team database, patient records and follow-up correspondence. Results: Ninety Dieulafoy lesions were identified in 89 patients after a mean of 1.9 endoscopies. Their mean age was 72 years. Thirty-four percent of lesions were extragastric. Median transfusion requirement was 5 units. Two patients exsanguinated and 3 required surgery; all others were initially successfully treated endoscopically (with or without epinephrine injection): heat probe (71 patients), band ligation (3), hemoclip (1), laser (2), bipolar probe (4), sclerotherapy (2) and epinephrine alone (2). Gastric perforation occurred in 1 patient following sclerotherapy. Thirty-day mortality was 13%, 4 related to hemorrhage and 5 related to comorbidity. During median follow-up of 17 months, 34 patients (42%) died. One patient had recurrent bleeding 6 years after operation. Conclusions: Dieulafoy lesion is relatively common and often extragastric. Endoscopic therapy is safe and effective. Long-term recurrence was not evident following endoscopic ablation. Followup after ablative therapy appears unnecessary.

Original languageEnglish (US)
Pages (from-to)762-767
Number of pages6
JournalGastrointestinal endoscopy
Volume50
Issue number6
DOIs
StatePublished - Jan 1 1999

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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    Norton, I. D., Petersen, B. T., Sorbi, D., Balm, R. K., Alexander, G. L., & Gostout, C. J. (1999). Management and long-term prognosis of Dieulafoy lesion. Gastrointestinal endoscopy, 50(6), 762-767. https://doi.org/10.1016/S0016-5107(99)70155-0