Dieulafoy’s lesion, from diagnosis to treatment: an endoscopic center experience

Aims Dieulafoy΄s lesion (DL) is a congenital vascular abnormality, a particularly large submucosalartery that has the potential to bleed through a small defect in the mucosa. It is anextremely rare but potentially life-threatening condition. Mostly misdiagnosed, it accounts foronly 1-2% of cases of acute gastrointestinal bleeding [1].The aim of our study was to determine the epidemiological and endoscopic characteristics ofthis condition and to assess the effectiveness of its management in our center.

Methods We conducted a retrospective study over the period from January 2015 to September 2024.including all patients who underwent upper gastrointestinal endoscopy and in whom a DLwas identified. Clinical data, endoscopic findings and therapeutic features were collected.

Results Thirteen patients were included, out of which 12 were identified by gastroscopy and one byenteroscopy. The mean age was 66 years [37 – 87] and the sex ratio M/F was 0.6. Themajority of patients (n=11) had significant comorbidities, mainly cardiovascular disease.Nearly half patients (n=7) were receiving anticoagulant or antiplatelet therapy. In mostcases, endoscopy was performed in emergency for upper gastrointestinal bleeding as theinitial symptom, as well as for acute anemia in one case. Only one patient was completelyasymptomatic, and fibroscopy was performed as part of the follow-up of her celiac disease.DL was often solitary, except in two patients with two lesions each. These lesions weremainly gastric (n=5), three were bulbar, two duodenal and another two jejunal, and onlyone was found in the eosophagus. The most frequent endoscopic finding was a small ulcer,observed in eight patients, either with or without signs of recent bleeding. In addition, aForrest Ia aspect was found in 3 cases, Forrest Ib in 4 cases and a visible vessel aspect(Forrest IIa) in 2 cases. An adherent clot was observed in 3 cases. Ten patients underwentmechanical endoscopic hemostasis by placement of hemoclips (average number of clips was2), combined with prior adrenaline injection in 3 cases. Coagulation with argon plasma wasnot performed in any case. Hemostasis was achieved in all cases except for one, where thepatient underwent successful radiological embolization after failure of endoscopic hemostasis(jejunal location). Another patient experienced a late recurrence after one month and wassuccessfully treated by hemostatic clipping.

Conclusions Bleeding from DL is typically massive but intermittent, which makes it one of the mostchallenging diagnoses to establish. With advances in digestive endoscopy, endoscopichemostasis has proved its effectiveness, and represents currently the treatment of choice forthe management of DL bleeding, as testified by our serie.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Baxter M, Aly EH.. Dieulafoy’s lesion: current trends in diagnosis and management. Ann R Coll Surg Engl 2010; 92 (7): 548