How is upper gastrointestinal bleeding (UGIB) caused by Dieulafoy lesions treated?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

The initial endoscopic management of a Dieulafoy lesion can be highly successful. In a report by Norton et al describing their experience with 90 Dieulafoy lesions, endoscopic management achieved primary hemostasis in 96% of cases. [137]  The 30-day mortality was 13%, which is a reflection of the severe comorbid conditions associated with patients who have bleeding from a Dieulafoy lesion. [137]

Contact thermal ablation with a heater probe is a very effective technique, with or without the combined use of epinephrine to slow or stop the bleeding prior to applying the heater probe. Argon plasma coagulation (APC) and endoclips have also been used successfully for hemostasis. No studies have been performed that compare surgical and endoscopic therapy for Dieulafoy lesions.

Although surgical intervention may be required after failed endoscopic therapy, endoscopy is still an important adjunct for management, because a nonbleeding Dieulafoy lesion may be undetectable through a gastrotomy.

Because of this potential problem, a combined endoscopic and surgical approach has been adopted. The vascular malformation can be marked with India ink through the endoscope.

Rebleeding after endoscopic therapy occurs in 11%-15% of cases, with most cases of rebleeding controlled at repeat endoscopy. [26] (Repeat endoscopy in patients who have rebleeding has been validated in controlled studies of endoscopy and surgery.)


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