Abstract

A STUDY ON DIEULAFOY’S LESION: PATHOGENESIS, DIAGNOSIS, TREATMENT

Sharmila Nirojini P., Asifa Shaz A.*, Bharathi J., Dahlia Dixcy S., Durga V., Anjana A. G.

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Abstract

Dieulafoy’s lesions (DLs) are rare and cause gastrointestinal bleeding resulting from erosion of dilated submucosal vessels. The most common location for DL is the stomach, followed by duodenum. Challenges for diagnosis and treatment of Dieulafoy’s lesions include the rare nature of the disease, asymptomatic patients, bleeding symptoms often requiring rapid diagnosis and treatment, variability in the diagnosis and treatment methods resulting from different lesion locations, and the risk of re-bleeding. For these reasons, there is no universal consensus about the diagnosis and treatment approach. 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.

Keywords: Dieulafoy lesion, GI bleeding, Endoscopy, Angiography, Gastrointestinal tract.