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2015 ; 48
(2
): 112-20
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Endoscopic Management of Dieulafoy s Lesion
#MMPMID25844338
Jeon HK
; Kim GH
Clin Endosc
2015[Mar]; 48
(2
): 112-20
PMID25844338
show ga
A Dieulafoy's lesion is a vascular abnormality consisting of a large
caliber-persistent tortuous submucosal artery. A small mucosal defect with the
eruption of this protruding vessel can cause bleeding. In fact, a Dieulafoy's
lesion is a relatively rare but potentially life-threatening condition. It
accounts for 1% to 2% of cases of acute gastrointestinal bleeding. Although there
is no consensus on the treatment of Dieulafoy's lesions; treatment options depend
on the mode of presentation, site of the lesion, and available expertise.
Endoscopic therapy is usually successful in achieving primary hemostasis, with
hemostasis success rates reaching 75% to 100%. Although various therapeutic
endoscopic methods are used to control bleeding in Dieulafoy's lesions, the best
method for endoscopic intervention is not clear. Combination endoscopic therapy
is known to be superior to monotherapy because of a lower rate of recurrent
bleeding. In addition, mechanical therapies including hemostatic clipping and
endoscopic band ligation are more effective and successful in controlling
bleeding than other endoscopic methods. Advances in endoscopic techniques have
reduced mortality in patients with Dieulafoy's lesion-from 80% to 8%-and
consequently, the need for surgical intervention has been reduced. Currently,
surgical intervention is used for cases that fail therapeutic endoscopic or
angiographic interventions.
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