Ferit ÇELİK, Ali ŞENKAYA, NALAN GÜLŞEN ÜNAL, Seymur ASLANOV, Abdullah Murat BUYRUK, Fatih TEKİN, Ahmet Ömer ÖZÜTEMİZ

Dieulafoy’s lesion as a rare cause of gastrointestinal bleeding: a single-center experience

To define the clinical characteristics of Dieulafoy’s lesion (DL),determine the localization features, and investigate endoscopic treatments and their results. This retrospective study included 20 patients who presented to the Department of Gastroenterology due to gastrointestinal (GI) bleeding between January 2015 and December 2019 and were diagnosed with DL. Age, gender, comorbidities, medications used, presentation findings, hemoglobin and hematocrit values at the time of presentation, number and type of transfusions if applied, length of hospitalization in days, mortality/survival, and endoscopic procedure parameters, including the number of procedures, localization of DL, type of bleeding stigmata, and the applied technique were recorded for all patients. Ten (50%) of the patients were women, and the mean age of all patients were 66.8±17.8 years. One or more comorbidities were present in 90% of the patients. The use of acetyl salicylic acid (ASA) was present in five (25%) patients, ASA+ clopidogrel in five (25%), warfarin in two (10%), and non-steroidal anti-inflammatory drugs in two (10%). The most common complaint was observed to be hematemesis and/or melena in 16 patients (80%). DL was most frequently seen in the stomach (n=10; 50%) where it was most commonly located in the proximal corpus (n=6; 60%). The most prevalent bleeding stigma was active bleeding, which was seen in nine (45%) patients during endoscopy. Eight (40%) patients received endoscopic treatment combined with a mechanical method, and nine (45%) patients only received a mechanical treatment (endoscopic band ligation or hemoclip). The median number of hospitalizations was five days (2-22). Transfusion was required by 13 patients (65%). The mortality rate was determined as 5%. DL should be considered especially in older patients with chronic diseases who present with recurrent GI bleeding. An endoscopic examination is the first method to be applied in the diagnosis and treatment of DL. Mechanical methods should be prioritized in endoscopic treatment.

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1. Baxter M, Aly EH. Dieulafoy’s lesion: current trends in diagnosis and management. Ann R Coll Surg Engl. 2010;92:548-54.

2. Sostres C, Lanas A. Epidemiology and demographics of upper gastrointestinal bleeding: prevalence, incidence, and mortality. Gastrointest Endosc Clin N Am. 2011;21:567-81.

3. Nagri S, Anand S, Arya Y. Clinical presentation and endoscopic management of Dieulafoy’s lesions in an urban community hospital. World J Gastroenterol. 2007;13:4333.

4. Morowitz M, Markowitz R, Kamath B, et al. Dieulafoy's lesion segmental dilatation of the small bowel: an uncommon cause of gastrointestinal bleeding. J Paediatr Surg. 2004;39:1726–8.

5. British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut. 2002;51:1-6.

6. Peumery JJ. Georges Dieulafoy (1839-1911) and the teaching of medicine in Paris at the hinge of the Second Empire and the Third Republic Vesalius. 2004;10:74- 7.

7. Romãozinho JM, Pontes JM, Lérias C, et al. Dieulafoy's lesion: management and long-term outcome. Endoscopy. 2004;36:416–20.

8. Blecker D, Bansal M, Zimmerman RL, et al. Dieulafoy's lesion of the small bowel causing massive gastrointestinal bleeding: two case reports and literature review. Am J Gastroenterol. 2001;96:902–5.

9. Ji JS, Kim HK, Kim SS, et al. Clinical outcome of endoscopic management of duodenal Dieulafoy’s lesions: endoscopic band ligation versus endoscopic hemoclip placement. Surg Endosc. 2016;30:3526-31.

10. Alis H, Oner OZ, Kalayci MU, et al. Is endoscopic band ligation superior to injection therapy for Dieulafoy lesion? Surg Endosc.2009;23:1465-9.

11. Marek TA. Gastrointestinal bleeding. Endoscopy.2007;39:998-1004.

12. Nojkov B, Cappell MS. Gastrointestinal bleeding from Dieulafoy’s lesion: clinical presentation, endoscopic findings, and endoscopic therapy. World J Gastrointest Endosc. 2015;7:295–307.

13. Alshumrani G, Almuaikeel M. Angiographic findings and endovascular embolization in Dieulafoy disease: a case report and literature review. Diagn Intervent Radiol. 2006;12:151–4.

14. Akpınar MY, Öztaş E, Derya A et al. Dieulafoylezyonunda endoskopik tedavi. Akademik Gastroenteroloji Dergisi. 2016;15:102-5.

15. Beyazit, Y, Dişibeyaz S, Suvak, B, et al. Dieulafoylezyonuna bağlı akut gastrointestinal system kanaması nedeniyle acil servise başvuran olguların tedavi sonuçlarının değerlendirilmesi. Ulus Travma Acil Cerrahi Derg. 2013;19:133-9.

16. Yılmaz M, Özütemiz Ö, Ersöz G, et al. Seyrek gorülen bir üst gastrointestinal system kanama nedeni: Dieulafoylezyonu. Turk J Gastroenterol. 1998;2:149.

17. Marchese M, De Cristofaro R, Federici AB, et al. Duodenal and gastric Dieulafoy's lesions in a patient with type 2A von Willebrand's disease. Gastrointest Endosc. 2005;61:322-5.

18. Chaer R, Helton WS. Dieulafoy’s disease. Am Coll Surg. 2003;196:290-6.

19. Scudiere JR, Cimbaluk D, Jakate S. A 74 year-old man with fatal gastrointestinal bleeding. Arch Pathol Lab Med. 2006;130:223–4.

20. Yoshikumi Y, Mashima H, Suzuki J, et al. A case of rectal Dieulafoy's ulcer and successful endoscopic band ligation. J Gastroenterol. 2006;20:287–90.

21. Park CH, Joo YE, Kim HS, et al. A prospective, randomized trial of endoscopic band ligation versus endoscopic hemoclip placement for bleeding gastric Dieulafoy’s lesions. Endoscopy. 2004;36:677- 81.

22. Valera JM, Pino RQ, Poniachik J, et al. Endoscopic band ligation of bleeding Dieulafoy lesions: the best therapeutic strategy. Endoscopy. 2006;38:193-4.

23. Chung IK, Kim EJ, Lee MS, et al. Bleeding Dieulafoy’s lesions and the choice of endoscopic method: comparing the hemostatic efficacy of mechanical and injection methods. Gastrointest Endosc. 2000;52:721-4.

24. Baettig B, Haecki W, Lammer F, et al. Dieulafoy's disease: endoscopic treatment and follow up. Gut. 1993;34:1418-21.

25. Yamaguchi Y, Yamato T, Katsumi N, et al. Short-term and longterm benefits of endoscopic hemoclip application for Dieulafoy’s lesion in the upper GI tract. Gastrointest Endosc. 2003;57:653-6.

26. Ljubicic N. Efficacy of endoscopic clipping and long-term followup of bleeding Dieulafoy's lesions in the upper gastrointestinal tract. Hepatogastroenterology. 2006;53:224–7.

27. Katsinelos P, Paroutoglou G, Mimidis K, et al. Endoscopic treatment and follow-up of gastrointestinal Dieulafoy's lesions. World J Gastroenterol. 2005;11:6022–6.

28. Brown GR, Harford WV, Jones WF. Endoscopic band ligation of an actively bleeding Dieulafoy lesion. Gastrointest Endosc.1994;40:501-3.

29. Lara LF, Sreenarasimhaiah J, Tang SJ, et al. Dieulafoy lesions of the GI tract: localization and therapeutic outcomes. Dig Dis Sci. 2010;55:3436-41.