Bleeding Dieulafoy Lesion Research Articles

Endoscopic Management and Follow Up of Dieulafoy Lesion in the Upper Gastrointestinal Tract

Dieulafoy's lesion is an important cause of upper gastrointestinal bleeding, and the safety and efficacy of endoscopic treatment have been widely accepted. The aim of this study was to evaluate the effectiveness of endoscopic management, including hemoclipping and injection methods, for bleeding Dieulafoy lesions in the upper gastrointestinal tract. Between 1995 and 2003, 61 patients with bleeding Dieulafoy lesions underwent endoscopic treatment. The available hemostatic methods were hemoclipping, hypertonic saline-epinephrine injection, and pure ethanol injection. Clinical data, endoscopic features, and treatment outcome were analyzed retrospectively. Comorbid conditions were present in 39 patients (64 %). Active bleeding was noted in 20 patients (33 %). Hemoclipping was a selected treatment in 48 patients (79 %). Initial hemostasis was achieved in 61 patients (100 %). One patient had rebleeding 6 days after the initial procedure but was successfully treated endoscopically. The 30-day mortality was 0 %. During follow-up, for a mean of 47 months, 15 patients (25 %) died of causes unrelated to the Dieulafoy lesion. Two patients had recurrent bleeding due to non-Dieulafoy gastric ulcer, and responded to endoscopic therapy. We encountered no patients who required surgery. Dieulafoy lesion can be successfully managed by endoscopic treatment. The long-term outcome is acceptable.

Is Endoscopic Band Ligation More Effective Than Electrocoagulation in the Treatment of Bleeding Dieulafoy's Lesion?

Is Endoscopic Band Ligation More Effective Than Electrocoagulation in the Treatment of Bleeding Dieulafoy's Lesion?

Endoscopic treatment and follow-up of gastrointestinal Dieulafoy's lesions

To investigate retrospectively the clinical and endoscopic features of bleeding Dieulafoy's lesions and to assess the short- and long-term effectiveness of endoscopic treatment. Twenty-three patients who had gastrointestinal bleeding from Dieulafoy's lesions underwent endoscopic therapy. Demographic data, mode of presentation, risk factors for gastrointestinal bleeding, blood transfusion requirements, endoscopic findings, details of endoscopic therapy, recurrence of bleeding and mortality rates were collected and analyzed retrospectively. Hemostasis was attempted by dextrose 50% plus epinephrine in 10 patients, hemoclipping in 8 patients, heater probe in 2 patients and ethanolamine oleate in 2 patients. Comorbid conditions were present in 17 patients (74%). Overall permanent hemostasis was achieved in 18 patients (78%). Initial hemostasis was successful with no recurrent bleeding in patients treated with hemoclipping, heater probe or ethanolamine injection. In the group of patients who received dextrose 50% plus epinephrine injection treatment, four (40%) had recurrent bleeding and one (10%) had unsuccessful initial hemostasis. Of the four patients who had rebleeding, three had unsuccessful hemostasis with similar treatment. Surgical treatment was required in five patients (22%) owing to uncontrolled bleeding, recurrent bleeding with unsuccessful retreatment and inability to approach the lesion. One patient (4.3%) died of sepsis after operation during hospitalization. There were no side-effects related to endoscopic therapy. None of the patients in whom permanent hemostasis was achieved presented with rebleeding from Dieulafoy's lesion over a mean long-term follow-up of 29.8 mo. Bleeding from Dieulafoy's lesions can be managed successfully by endoscopic methods, which should be regarded as the first choice. Endoscopic hemoclipping therapy is recommended for bleeding Dieulafoy's lesions.

SIR OCCAM ITʼS DOUBLE JEOPARDY

We describe a patient with two obscure sources of bleeding at once. Case Report: A 73-year-old African American man with a hx of alcoholisim and chronic pancreatitis(CP) was transferred to our institution with the diagnosis of UGI bleeding with large transfusion requirement. The patient had been admitted to an outside hospital with a hgb of 5.3 after complaining of mid-epigastric abdominal pain and melena occurring for 1 month. EGD was performed twice prior to transfer along with soft and colonoscopy that failed to reveal a source of bleeding. A CT of the abdomen revealed a dilated PD with 'chain of lakes' and CP. Repeat EGD was performed at our institution and revealed an actively bleeding Dieulafoy's lesion(DL) in the region of the posterior duodenal bulb that was treated with injections of epinephrine and gold probe application with good hemostasis. The next week he again experienced melena and was admitted with an hgb of 4. EGD was performed for the fourth time finding fresh blood in the duodenal bulb and ulceration from the previous endoscopic therapy. A side viewing ERCP scope revealed bright red blood intermittently welling up from the ampulla admixed with bile. [figure 1]Embolization was unsuccessful and the patient was not an operative candidate. Post-mortem examination revealed a 2 cm hemmorhagic pseudocyst.FigureDiscussion: This is the first case described of a bleeding DL in association with HP. In addition, this case highlights the difficulty and pitfalls in obtaining a diagnosis in HP emphasizing the need for a high index of suspicion in patients with obscure bleeding. Occam's razor is a logical principle attributed to the mediaeval philosopher William of Occam. The principle states that, “One should not increase, beyond what is necessary, the number of entities required to explain anything.” It underlies all scientific modeling and theory building. In this case, as with all cases of GI bleeding, it is important to consider all possibilities and to continue to evaluate the patient in a dynamic manner with the realization that Occam's razor may not always apply.

Endoscopic management and long-term follow-up of Dieulafoy's lesions in the upper GI tract

Background: The aim of this study was to retrospectively evaluate the short-and long-term effectiveness of different methods of endoscopic treatment for bleeding Dieulafoy's lesions. Methods: Patients were allocated into 2 groups according to the hemostatic method applied: (1) injection group (epinephrine and/or ethanolamine oleate), and (2) thermal coagulation group (heat probe), either alone or combined with epinephrine injection. The combination of epinephrine and ethanolamine oleate was used in 5 patients, epinephrine alone in 3, ethanolamine oleate alone in one, heat probe and epinephrine in 8, and heat probe alone in 1 patient. Results: Dieulafoy's lesions were found in 18 (1%) of 1750 patients with acute nonvariceal upper GI bleeding. Comorbid conditions were present in 5 (28%) patients. Initial hemostasis was achieved endoscopically in 13 patients (72%) and permanent hemostasis in 17 patients (94%). Bleeding recurred in 5 patients (2 with concomitant disease) in the injection group; 3 were successfully retreated by heat probe coagulation and epinephrine injection, 1 with hemoclip application and 1 by surgery. There was no recurrent bleeding in thermal treatment group. Thermal treatment was significantly superior to injection (p = 0.0029). Conclusions: Endoscopic thermal coagulation with or without epinephrine injection should be the initial treatment of choice for Dieulafoy's lesions. Mortality is lowest in patients with no significant comorbidity and an unremarkable medical history. (Gastrointest Endosc 2002;55:527-31.)

Comparison of endoscopic band ligation and injection therapy for bleeding dieulafoy's lesion

Comparison of endoscopic band ligation and injection therapy for bleeding dieulafoy's lesion

Bleeding Dieulafoy's lesions and the choice of endoscopic method: Comparing the hemostatic efficacy of mechanical and injection methods

Bleeding Dieulafoy's lesions and the choice of endoscopic method: Comparing the hemostatic efficacy of mechanical and injection methods

Bleeding Dieulafoy's lesions and the choice of endoscopic method: Comparing the hemostatic efficacy of mechanical and injection methods

Background: Dieulafoy's lesion has unique endoscopic and histopathologic characteristics. This is a clinical trial of endoscopic therapy in 24 patients with Dieulafoy's lesions. Methods: Patients were divided into 2 groups according to initial endoscopic treatment method. Data were analyzed with respect to clinical and endoscopic characteristics as well as outcomes. The 24 patients were evenly divided into mechanical (9 hemoclipping, 3 band ligation) and injection groups (12). Results: The average number of therapeutic endoscopic sessions needed to achieve permanent hemostasis for the mechanical and injection groups were 1.17 and 1.67, respectively. Initial hemostasis was achieved in 91.7% of patients undergoing mechanical therapy and 75% of those undergoing injection therapy, with none in the former group needing subsequent surgery in comparison to 17% of the latter group.The rate of recurrent bleeding in the mechanical therapy group was significantly lower in comparison to the injection therapy group (8.3% versus 33.3%, p < 0.05). Conclusions: Higher efficacy in terms of initial hemostasis and less recurrent bleeding was achieved by mechanical hemostatic therapy with hemoclip and band ligation compared with injection therapy. Endoscopic mechanical therapy is recommended as effective for bleeding Dieulafoy's lesions. (Gastrointest Endosc 2000;52:721-4.)

Thermal probe or combination therapy for nonvariceal upper gastrointestinal hemorrhage

Nonvariceal upper gastrointestinal (UGI) hemorrhage is a common reason for emergency care and hospitalization. Ulcer bleeding accounts for about 50% of the cases, and less common causes are angiomas, Mallory-Weiss tears, Dieulafoy's lesion, and UGI cancers. My specific purposes are: (1) to consider the details of care before emergency endoscopy and the timing of therapeutic endoscopy, (2) to describe the techniques that the Center for Ulcer Research and Education (CURE) Hemostasis Research Group uses for endoscopic hemostasis of different stigmata of ulcer hemorrhage, and (3) to detail the techniques for treatment of bleeding Mallory-Weiss tears and Dieulafoy's lesions. The emphasis is more on the methods than the results of endoscopic hemostasis. There has been significant progress and changes in the care of patients with nonvariceal UGI hemorrhage in the last 2 decades and these developments will be discussed. Examples of changes that have become the standard of care are the following: using stigmata of ulcer hemorrhage for prognostication, choosing different techniques for endoscopic hemostasis of different stigmata of ulcer hemorrhage, and use of algorithms for endoscopic treatment of bleeding Mallory-Weiss tears and Dieulafoy's lesions. Standardized approaches to the diagnosis and treatment are now recommended because they have been show to significantly improve the condition of patients with severe nonvariceal hemorrhage.

Endoscopic band ligation of a Dieulafoy lesion in the small intestine of a child

A Dieulafoy lesion is a small mucosal erosion into a caliber-persistent, unusually large, submucosal artery.1 The lesion is named after G. Dieulafoy, whose initial description was published in 1898.2 Although the lesion most commonly occurs in older men,3-5 reports in children exist and imply a possible congenital cause.5-10 Dieulafoy lesions are typically located in the proximal stomach, although they have also been found in the duodenum,5,11,12 jejunum,4,13,14 colon,15,16 and esophagus.17 Surgery has been considered the treatment of choice for bleeding Dieulafoy lesions.

Endoscopic band ligation of an actively bleeding Dieulafoy lesion

A Dieulafoy lesion is a small mucosal erosion involving an unusually large sub-mucosal artery. The lesion is usually located high in the proximal stomach, but non-gastric locations have also been described.1-3 The artery is an anatomic variant, with persistence of the caliber of a sub-serosal artery as it penetrates the muscularis propria.4 Dieulafoy lesions are associated with massive and recurrent gastrointestinal hemorrhage.2,4 Untreated hemorrhage from a Dieulafoy lesion carries a mortality rate of up to 79.

Combined use of laparoscopy and endoscopy in diagnosing and treating dieulafoy's vascular malformations of the stomach

We present the case of a 70-year-old female successfully treated for a bleeding Dieulafoy's gastric lesion with a combined laparoscopic/endoscopic approach. An increasing percentage of surgery is now being performed laparoscopically and the authors feel that combined laparoscopic/endoscopic surgery offers advantages to the patient over either of these methods individually and over open surgery. This report demonstrates that a bleeding point anywhere on the gastric wall is amenable to laparoscopic intervention if the localization techniques we describe are utilized.

Dieulafoy's disease: endoscopic treatment and follow up.

The findings from 480 patients who had emergency endoscopy for acute upper gastrointestinal bleeding of non-variceal origin at our institution were analysed. Twenty eight patients (5.8%) had a Dieulafoy lesion. In 27 patients (96.4%) bleeding could be successfully managed by injection of norepinephrine and polidocanol, in repeated sessions if needed. Two patients had to be treated surgically: one because of uncontrollable bleeding from the Dieulafoy lesion and one despite endoscopic control of the bleeding Dieulafoy lesion because of a concomitant bleeding from an anastomosal ulcer after gastric resection. Three patients died during hospital stay from causes unrelated to bleeding from Dieulafoy lesion. Out of the 25 patients discharged from the hospital 21 treated by endoscopy and two treated with surgery were followed up for a mean of 28.3 and 22.5 months, respectively. Twenty endoscopically treated patients (95%) had no recurrence of Dieulafoy's bleeding. One patient experienced severe rebleeding from the original site after a transient endoscopy confirmed complete disappearance. He had emergency operation without a further attempt to control bleeding by endoscopy. It is concluded that bleeding from Dieulafoy's disease can be successfully managed by endoscopic injection treatment. The longterm outcome is favourable.

Nd:YAG laser treatment of a bleeding Dieulafoy's lesion

Dieulafoy's lesion,! also known as exulceratio simplex and submucosal arterial malformation, is a rare cause of massive gastrointestinal hemorrhage. The entity was first described in 1884 by Gallard and later characterized by the french surgeon George Dieulafoy in 1896. The lesion appears to be a large tortuous submucosal artery which usually develops in the stomach and ruptures for reasons not well understood. The resulting hemorrhage is massive. Endoscopy is the best means of making the diagnosis. Surgical intervention has been the therapy of choice in most reported cases. We report a case in which endoscopic Nd:YAG laser photocoagulation was used successfully in the management of this lesion.

Double channel pylorus as a complication of carcinoma of the stomach

and alcohol intake seem to be common antecedent factors. I Preceding symptoms can be dyspeptic in nature. I The diagnosis may require multiple endoscopies, arteriography, and sometimes laparotomy. Mortality is high. I Treatment is usually surgical and the lesion is either oversewed or excised. Electrocoagulation was partially successful in one patient. I Laser photocoagulation has been used in the treatment of a variety of bleeding gastrointestinal lesions including gastric and duodenal ulcers, arteriovenous malformations, and Mallory-Weiss tears. We found no reports in the English literature describing its use in treating bleeding Dieulafoy's lesions. In our case, Nd:YAG laser photocoagulation was successful in avoiding a high risk operation by elimination of the lesion as documented by repeat endoscopy. The small ulcer seen by repeat endoscopy is probably the result of laser therapy. Since no histologic data are available from our patient, we cannot comment on the long-term follow-up and the possibility of recurrent bleeding in the future. Laser photocoagulation is not without hazard when used in the treatment of Dieulafoy's lesion since vaporization instead of coagulation can lead to exacerbation of bleeding. It is therefore advisable to apply treatment as short high-energy bursts around the lesion before treating the center of the lesion.