Abstract No. 395 - Endovascular treatment options for a Dieulafoy’s lesion

Abstract

1. Define a Dieulafoy’s lesion. 2. Review endoscopic and surgical management of this condition. 3. Outline endovascular treatment options. Dieulafoy’s lesion is a rare condition involving a single large tortuous submucosal artery most commonly found in the lesser curvature of the stomach. This can erode through the gastric mucosa and may spontaneously rupture, resulting in life threatening hemorrhage. Historically these lesions were treated with surgery. Current treatment options primarily involve endoscopy. However, there is a growing role, for endovascular management of this disease process. Patients with Dieulafoy’s lesion often present with massive gastrointestinal (GI) hemorrhage that may be recurrent in nature. Endoscopic management is generally considered a first line treatment option. However, endoscopy may be unrevealing, particularly if bleeding is brisk and the lesion is obscured by overlying mucosa. Mesenteric angiography should be considered for all patients with massive upper GI hemorrhage and no history, imaging, or endoscopic data to suggest a variceal source. Dieulafoy’s lesion may be managed by coiling this abnormally sized vessel along its course. However, as these vessels may arise through a process of intragastric collateral formation due to underlying conditions such as splenic artery thrombosis, patients should be closely followed to monitor for potential re-bleeding. The current presentation will review options for the treatment of Dieulafoy’s lesion. Additionally, case examples will be provided to demonstrate the endovascular management of this condition. Dieulafoy’s lesion is a rare and under-diagnosed source of massive GI hemorrhage. This condition should be considered in the setting of non-variceal, massive upper GI hemorrhage. Angiography and embolization may be employed as an adjunct to endoscopic management, particularly in cases where the lesion is not directly accessible by endoscopy or the diagnosis is unclear. These patients should be closely followed in the post-procedural period due to high recurrence and re-bleeding rates.