Outcomes in Dieulafoy’s Lesion: A 10-Year Clinical Review

• Published in: Digestive diseases and sciences 2015-07, Vol.60 (7), p.2097-2103
• Main Authors: Kanth, Rajan, Mali, Padmavathi, Roy, Praveen K.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anemia; Arteries - pathology; Biochemistry; Care and treatment; Comorbidity; Embolization, Therapeutic; Endoscopy; Endoscopy, Gastrointestinal; Epinephrine - administration & dosage; Epinephrine - therapeutic use; Female; Gastric Mucosa - blood supply; Gastroenterology; Gastrointestinal Hemorrhage - etiology; Hemostasis, Endoscopic - methods; Hemostatics - administration & dosage; Hepatology; Humans; Intestinal Mucosa - blood supply; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mortality; Oncology; Original Article; Patient outcomes; Pneumoviridae; Retrospective Studies; Transplant Surgery; Treatment Outcome
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-015-3568-1

Background Dieulafoy’s lesion (DL) is a rare, but serious cause of gastrointestinal bleeding, most frequently treated with endoscopic therapy. We examined 10 years of data to assess clinical outcomes in DL. Methods Data were captured by retrospective chart review to assess 109 patients treated endoscopically for bleeding DL from 2003 to 2013. Data collected included demographics, comorbidities, presenting symptoms, risk factors, laboratory values, treatment, rebleeding, surgical intervention, and mortality. Treatment success, rebleeding rates, and mortality were the main outcomes measured. Results Of 109 patients with bleeding DL, 54 % were male and 46 % were female. Mean age was 79.4 years; mean follow-up duration was 40.4 ± 35.8 months. Clinical presentation for most patients included melena, hematemesis, hematochezia, and/or anemia with approximately one-third of patients also experiencing anemia-related symptoms. Most lesions were located in stomach (53 %) followed by duodenum/jejunum (33 %) and large intestine (13 %). Thermal endoscopic therapy (70 %) was the most frequently performed procedure followed by injection (46 %) and mechanical (46 %) endoscopy therapy at equal frequency. Combined therapy (51 %) was common, with over half of patients undergoing two or more endoscopic modalities simultaneously. The finding that only 11 (10 %) patients had rebleeding from DL suggests that endoscopic therapy resulted in successful hemostasis in the remaining 98 patients (90 %) during follow-up. Mortality related to DL was low. Conclusions Most patients with bleeding DL presented with symptoms of acute bleeding, but many had symptoms suggesting subacute or chronic bleeding. Endoscopic therapy resulted in successful hemostasis in approximately 90 % of patients during follow-up. Rebleeding was rare and particularly uncommon in those treated with combined endoscopic therapy.