Bleeding from Dieulafoy's ulcer in the proximal stomach: endoscopic diagnosis and treatment with long-term follow-up

Objective: To assess the effectiveness of endoscopic diagnosis and treatmen t as well as the long-term course in patients with bleeding from Deulafoy's ulcer (DU). Patients and methods: Data were gathered on all cases coded "bleeding from dieulafoy's ullcer" in an endoscopic data-bank. The following items were ob tained from the case-notes: clinical symptoms, mean haemoglobin concentrati on, demand for infusion of erythrocyte concentrates and endoscopic procedur es undertaken for diagnosis and treatment. There were 15 patients (mean age 64.8 years; 9 men and 6 women), seen between 1985 and 1998 with the diagno sis of DU. All lesions were located in the proximal stomach. The effectiven ess of the various parameters was analysed. The long-term course was ascert ained by telephone interviews with the patients and (or) their general prac tioner. Results: The suspected diagnosis of DU was confirmed by additional endoscop ic means such as endoscopic Doppler sonography or endosonography. A combina tion of endoscopic techniques of stopping the bleeding (epinephrine injecti on and, if necessary, haemoclip application) was effective in 14 of 15 pati ents, operative intervention being required in one. Three patients died dur ing follow-up, none of bleeding. No recurrence of bleeding had occurred in the 10 patients followed for a mean of 20 (6-31) months. Conclusions: The endoscopic diagnosis of DU bleeding can be confirmed by en doscopic Doppler sonography or endosonography. It remains to be proven whet her miniscope endosonography is of additional value. The combined method of stopping the bleeding has been effective in this patient-collective, both during hospitalization and on long-term follow-up.