Management and long-term prognosis of Dieulafoy lesion

Gastrointest Endosc. 1999 Dec;50(6):762-7. doi: 10.1016/s0016-5107(99)70155-0.


Background: The Dieulafoy lesion is an important cause of gastrointestinal (GI) hemorrhage. Optimal treatment and long-term outcome are unknown. This study aimed to characterize the presentation of the Dieulafoy lesion and to summarize the results and report the long-term outcome of endoscopic therapy.

Methods: Data regarding diagnosis, treatment and outcomes were derived from our GI Bleed Team database, patient records and follow-up correspondence.

Results: Ninety Dieulafoy lesions were identified in 89 patients after a mean of 1.9 endoscopies. Their mean age was 72 years. Thirty-four percent of lesions were extragastric. Median transfusion requirement was 5 units. Two patients exsanguinated and 3 required surgery; all others were initially successfully treated endoscopically (with or without epinephrine injection): heat probe (71 patients), band ligation (3), hemoclip (1), laser (2), bipolar probe (4), sclerotherapy (2) and epinephrine alone (2). Gastric perforation occurred in 1 patient following sclerotherapy. Thirty-day mortality was 13%, 4 related to hemorrhage and 5 related to comorbidity. During median follow-up of 17 months, 34 patients (42%) died. One patient had recurrent bleeding 6 years after operation.

Conclusions: Dieulafoy lesion is relatively common and often extragastric. Endoscopic therapy is safe and effective. Long-term recurrence was not evident following endoscopic ablation. Follow-up after ablative therapy appears unnecessary.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arteriovenous Malformations / diagnosis
  • Arteriovenous Malformations / mortality
  • Arteriovenous Malformations / therapy*
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Gastroscopy*
  • Humans
  • Male
  • Middle Aged
  • Peptic Ulcer Hemorrhage / diagnosis
  • Peptic Ulcer Hemorrhage / mortality
  • Peptic Ulcer Hemorrhage / therapy*
  • Recurrence
  • Stomach / blood supply*
  • Stomach Ulcer / diagnosis
  • Stomach Ulcer / mortality
  • Stomach Ulcer / therapy*
  • Treatment Outcome