GASTROENTEROLOGY ARTICLE OF THE WEEK
October 30, 2003
Lee YT, Walmsley RS, Leong RW, Sung JJ. Dieulafoy’s Lesion. Gastrointestinal Endosc 2003;58:236-243.
1. Dieulafoy’s Lesion (DL):
a. represents the earliest stage of an ulcer
b. represents protrusion of an abnormally large caliber artery through a mucosal
defect
c. represents an aneurysmal dilation of a submucosal vessel
d. the bleeding is caused by inflammation adjacent to the vessel
e. is a congenital lesion
2. Criteria for diagnosis of DL include
a. active arterial spurting or micropulsatile streaming of blood from a <3mm
defect in the mucosa
b. an otherwise normal endoscopy with no other lesions such as ulcers or
erosions
c. visualization of a protruding vessel, with or without active bleeding, within a
minute mucosal defect or with surrounding normal mucosa.
d. fresh, densely adherent clot with a narrow point of attachment to a minute
mucosal defect or to normal-appearing mucosa
3. Endoscopic therapy for DL
a. injection monotherapy stops bleeding in 95% with a recurrence rate of up to
55%
b. thermal therapy monotherapy is as effective as injection therapy
c. combination injection and thermal therapy is preferred to either modality
alone.
d. if recurrent bleeding occurs after initial endoscopic hemostasis, a second trial
at endoscopic therapy should not be done.
True or False
4. Patients with H. pylori infection are more likely to bleed from a DL.
5. The most common location for DL is in the stomach, lesser curvature, within 6cm of the GE junction.
6. Endoscopic therapy achieves hemostasis in >90% of cases
7. Tattooing should be considered in case additional endoscopic intervention or surgery is needed after initial hemostasis.
8. Rescue surgery is needed in 3% to 16% of cases.
9. Mechanical hemostasis (banding or hemoclip) is particularly successful in proximal gastric lesions and those found to have a protruding vessel or active bleeding.