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. 1993 Oct;34(10):1418–1421. doi: 10.1136/gut.34.10.1418

Dieulafoy's disease: endoscopic treatment and follow up.

B Baettig 1, W Haecki 1, F Lammer 1, R Jost 1
PMCID: PMC1374553  PMID: 8244112

Abstract

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 (5.8%) had a Dieulafoy lesion. In 27 patients (96.4%) 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 28.3 and 22.5 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.

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Selected References

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  1. Bakka A., Rosseland A. R. Massive gastric bleeding from exulceratio simplex (Dieulafoy). Acta Chir Scand. 1986 Apr;152:285–288. [PubMed] [Google Scholar]
  2. Boron B., Mobarhan S. Endoscopic treatment of Dieulafoy hemorrhage. J Clin Gastroenterol. 1987 Oct;9(5):518–520. doi: 10.1097/00004836-198710000-00005. [DOI] [PubMed] [Google Scholar]
  3. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 41-1991. A 76-year-old man with recurrent gastrointestinal bleeding. N Engl J Med. 1991 Oct 10;325(15):1086–1096. doi: 10.1056/NEJM199110103251508. [DOI] [PubMed] [Google Scholar]
  4. De Jaureguiberry J. P., Moreau X., Duval J. L., Theobald X., Quinot J. F. Sclérothérapie endoscopique d'une ulcération de Dieulafoy de siège duodénal. Presse Med. 1991 Jan 26;20(3):128–128. [PubMed] [Google Scholar]
  5. Durham J. D., Kumpe D. A., Rothbarth L. J., Van Stiegmann G. Dieulafoy disease: arteriographic findings and treatment. Radiology. 1990 Mar;174(3 Pt 2):937–941. doi: 10.1148/radiology.174.3.174-3-937. [DOI] [PubMed] [Google Scholar]
  6. Eidus L. B., Rasuli P., Manion D., Heringer R. Caliber-persistent artery of the stomach (Dieulafoy's vascular malformation). Gastroenterology. 1990 Nov;99(5):1507–1510. doi: 10.1016/0016-5085(90)91183-7. [DOI] [PubMed] [Google Scholar]
  7. Goldenberg S. P., DeLuca V. A., Jr, Marignani P. Endoscopic treatment of Dieulafoy's lesion of the duodenum. Am J Gastroenterol. 1990 Apr;85(4):452–454. [PubMed] [Google Scholar]
  8. Goossens A., Pipeleers-Marichal M., Peeters O., Delvaux G. Solitary exulceratio simplex (ulcer of Dieulafoy). Acta Chir Belg. 1989 Jan-Feb;89(1):54–57. [PubMed] [Google Scholar]
  9. Helliwell M., Irving J. D. Haemorrhage from gastric artery aneurysms. Br Med J (Clin Res Ed) 1981 Feb 7;282(6262):460–461. doi: 10.1136/bmj.282.6262.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Juler G. L., Labitzke H. G., Lamb R., Allen R. The pathogenesis of Dieulafoy's gastric erosion. Am J Gastroenterol. 1984 Mar;79(3):195–200. [PubMed] [Google Scholar]
  11. Lin H. J., Lee F. Y., Tsai Y. T., Lee S. D., Lee C. H., Kang W. M. Therapeutic endoscopy for Dieulafoy's disease. J Clin Gastroenterol. 1989 Oct;11(5):507–510. doi: 10.1097/00004836-198910000-00005. [DOI] [PubMed] [Google Scholar]
  12. McClave S. A., Goldschmid S., Cunningham J. T., Boyd W. P., Jr Dieulafoy's cirsoid aneurysm of the duodenum. Dig Dis Sci. 1988 Jul;33(7):801–805. doi: 10.1007/BF01550966. [DOI] [PubMed] [Google Scholar]
  13. Mikó T. L., Thomázy V. A. The caliber persistent artery of the stomach: a unifying approach to gastric aneurysm, Dieulafoy's lesion, and submucosal arterial malformation. Hum Pathol. 1988 Aug;19(8):914–921. doi: 10.1016/s0046-8177(88)80006-6. [DOI] [PubMed] [Google Scholar]
  14. Molnár P., Mikó T. Multiple arterial caliber persistence resulting in hematomas and fatal rupture of the gastric wall. Am J Surg Pathol. 1982 Jan;6(1):83–86. doi: 10.1097/00000478-198201000-00011. [DOI] [PubMed] [Google Scholar]
  15. Nicolet M., Cuttat J. F., Dorta G., Fried M., Blum A. L. Exulceratio simplex Dieulafoy de l'estomac: à propos de 5 cas. Schweiz Med Wochenschr. 1990 Sep 29;120(39):1421–1424. [PubMed] [Google Scholar]
  16. Peitsch W., Lange W., Schauer A. Die Exulceratio simplex Dieulafoy. Eine seltene, aber ernste Ursache der akuten oberen Gastrointestinalblutung. Dtsch Med Wochenschr. 1987 Dec 11;112(50):1940–1942. doi: 10.1055/s-2008-1068358. [DOI] [PubMed] [Google Scholar]
  17. Pointner R., Schwab G., Königsrainer A., Dietze O. Endoscopic treatment of Dieulafoy's disease. Gastroenterology. 1988 Mar;94(3):563–566. doi: 10.1016/0016-5085(88)90224-7. [DOI] [PubMed] [Google Scholar]
  18. Richards W. O., Grove-Mahoney D., Williams L. F. Hemorrhage from a Dieulafoy type ulcer of the colon: a new cause of lower gastrointestinal bleeding. Am Surg. 1988 Feb;54(2):121–124. [PubMed] [Google Scholar]
  19. Schwab G., Pointner R., Feichtinger J., Schmidt K. W., Schmid K. W. Exulceratio simplex Dieulafoy of the colon--a case report. Endoscopy. 1988 Mar;20(2):88–89. doi: 10.1055/s-2007-1018143. [DOI] [PubMed] [Google Scholar]
  20. Schwesinger G., Scülfort H. Exulceratio simplex Dieulafoy. Z Gesamte Inn Med. 1987 Nov 15;42(22):654–656. [PubMed] [Google Scholar]
  21. Umlauft M., Zimmermann G. Die Exulceratio simplex Dieulafoy. Wien Klin Wochenschr. 1977 Jun 10;89(12):404–406. [PubMed] [Google Scholar]
  22. Veldhuyzen van Zanten S. J., Bartelsman J. F., Schipper M. E., Tytgat G. N. Recurrent massive haematemesis from Dieulafoy vascular malformations--a review of 101 cases. Gut. 1986 Feb;27(2):213–222. doi: 10.1136/gut.27.2.213. [DOI] [PMC free article] [PubMed] [Google Scholar]

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