Brief Reports
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2005; 11(38): 6022-6026
Published online Oct 14, 2005. doi: 10.3748/wjg.v11.i38.6022
Endoscopic treatment and follow-up of gastrointestinal Dieulafoy's lesions
Panagiotis Katsinelos, George Paroutoglou, Kostas Mimidis, Athanasios Beltsis, Basilios Papaziogas, George Gelas, Yiannis Kountouras
Panagiotis Katsinelos, George Paroutoglou, Kostas Mimidis, Athanasios Beltsis, George Gelas, Department of Endoscopy and Motility Unit, "G. Gennimatas" Hospital, Ethnikis Aminis 41, Thessaloniki 54635, Greece
Basilios Papaziogas, 2nd Surgical Clinic, "G.Gennimatas" Hospital, Aristotle University of Thessaloniki, Ethnikis Aminis 41, Thessaloniki 54635, Greece
Yiannis Kountouras, 2nd Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Greece
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Panagiotis Katsinelos, Department of Endoscopy and Motility Unit, "G. Gennimatas"Hospital, Ethnikis Aminis 41, Thessaloniki 54635, Greece. pantso@the.forthnet.gr
Telephone: +30-2310-211221 Fax: +30-2310-210401
Received: November 30, 2004
Revised: January 23, 2005
Accepted: January 26, 2005
Published online: October 14, 2005
Abstract

AIM: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Keywords: Endoscopic treatment; Dieulafoy lesion; Gastrointestinal tract