https://www.giejournal.org/article/S0016-5107%2803%2980118-9/pdf

Dieulafoy's lesion.

https://www.giejournal.org/article/S0016-5107(99)70155-0/pdf

Management and long-term prognosis of Dieulafoy lesion.

The findings from 480 patients who had emergency endoscopy for acute upper gastrointestinal bleeding of non-variceal origin at our institution were analysed Twenty eight patients (58%) had a Dieulafoy lesion In 27 patients (964%) bleeding could be successfully managed by injection of norepinephrine and polidocanol, in repeated sessions if needed Two patients had to be treated surgically: one because of uncontrollable bleeding from the Dieulafoy lesion and one despite endoscopic control of the bleeding Dieulafoy lesion because of a concomitant bleeding from an anastomosal ulcer after gastric resection Three patients died during hospital stay from causes unrelated to bleeding from Dieulafoy lesion Out of the 25 patients discharged from the hospital 21 treated by endoscopy and two treated with surgery were followed up for a mean of 283 and 225 months, respectively Twenty endoscopically treated patients (95%) had no recurrence of Dieulafoy's bleeding One patient experienced severe rebleeding from the original site after a transient endoscopy confirmed complete disappearance He had emergency operation without a further attempt to control bleeding by endoscopy It is concluded that bleeding from Dieulafoy's disease can be successfully managed by endoscopic injection treatment The longterm outcome is favourable

https://gut.bmj.com/content/gutjnl/34/10/1418.full.pdf

Dieulafoy's disease: endoscopic treatment and follow up.

https://www.giejournal.org/article/S0016-5107(92)70513-6/pdf

Clinical features and endoscopic management of Dieulafoy's disease.

Obscure gastrointestinal bleeding has been defined as bleeding from a source that cannot be readily determined by conventional investigations, such as barium studies and endoscopic investigation. In some series, it can account for up to 5% of all hemorrhages, and the source is often elusive because the culprit lesions are anatomically inaccessible, small, or subtle. Among the causes of obscure gastrointestinal bleeding, Dieulafoy’s lesions are one of the more treacherous and life threatening, because bleeding is often massive and recurrent. Initially described by Gallard in 1884, this cause of bleeding was more accurately characterized later by the French surgeon Georges Dieulafoy in 1896 as the “exulceratio simplex” and subsequently carried his name after he reported three fatal gastric hemorrhages in asymptomatic young men. This abnormality has also been referred to as Dieulafoy’s ulcer, Dieulafoy’s disease, gastric aneurysm, gastric arteriosclerosis, submucosal arterial malformation, cirsoid aneurysm, caliber persistent artery, and solitary exulceratio simplex. It has been described as unrecognized rather than rare, yet its reported incidence as a source of upper gastrointestinal bleeding ranges from 0.3% to 6.7%. Dieulafoy’s disease is found in 1% to 2% of patients undergoing operations for upper gastrointestinal hemorrhage. Unless the proper diagnosis is made, this entity can be associated with a high mortality despite the availability of multiple therapeutic modalities.

https://www.journalacs.org/article/S1072-7515(02)01801-X/pdf

Dieulafoy's disease.

Dieulafoy's disease is an underdiagnosed cause of massive upper gastrointestinal bleeding. The mortality rate is extremely high and the diagnosis is usually made at autopsy. Operation has been deemed the treatment of choice for Dieulafoy's disease in the past decades. Here, however, we report successful therapeutic endoscopy in eight cases of Dieulafoy's disease in a period of 20 months. Six patients (75%) were in shock before therapy. Six received heat-probe thermocoagulation, one received pure alcohol (99.8%) injection and one received hypertonic glucose solution (50%) injection. No perforation or recurrent hemorrhage occurred in the following period of 11.2 +/- 3.4 months (SEM) in six patients. The other two died of unrelated illness. In the near future, therapeutic endoscopy may replace surgery in the management of Dieulafoy's disease.

Wei Ming Kang

Papers

Therapeutic endoscopy for Dieulafoy's disease.