DIEULAFOYS DISEASE - ENDOSCOPIC TREATMENT AND FOLLOW-UP

The findings from 480 patients who had emergency endoscopy for acute u pper gastrointestinal bleeding of non-variceal origin at our instituti on were analysed. Twenty eight patients (5.8%) had a Dieulafoy lesion. In 27 patients (96.4%) bleeding could be successfully managed by inje ction of norepinephrine and polidocanol, in repeated sessions if neede d. Two patients had to be treated surgically: one because of uncontrol lable bleeding from the Dieulafoy lesion and one despite endoscopic co ntrol of the bleeding Dieulafoy lesion because of a concomitant bleedi ng from an anastomosal ulcer after gastric resection. Three patients d ied during hospital stay from causes unrelated to bleeding from Dieula foy lesion. Out of the 25 patients discharged from the hospital 21 tre ated by endoscopy and two treated with surgery were followed up for a mean of 28.3 and 22.5 months, respectively. Twenty endoscopically trea ted patients (95%) had no recurrence of Dieulafoy's bleeding. One pati ent experienced severe rebleeding from the original site after a trans ient endoscopy confirmed complete disappearance. He had emergency oper ation without a further attempt to control bleeding by endoscopy. It i s concluded that bleeding from Dieulafoy's disease can be successfully managed by endoscopic injection treatment. The longterm outcome is fa vourable.