Management and long-term prognosis of Dieulafoy lesion

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 thera py. 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 me an 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 su ccessfully treated endoscopically (with or without epinephrine injection): heat probe (71 patients), band ligation (3), hemoclip (1), laser (2), bipol ar probe (4), sclerotherapy (2) and epinephrine alone (2). Gastric perforat ion occurred in I patient following sclerotherapy. Thirty-day mortality was 13%, 4 related to hemorrhage and 5 related to comorbidity. During median f ollow-up of 17 months, 34 patients (42%) died. One patient had recurrent bl eeding 6 years after operation. Conclusions: Dieulafoy lesion is relatively common and often extragastric. Endoscopic therapy is safe and effective. Long-term recurrence. was not evi dent following endoscopic ablation. Followup after ablative therapy appears unnecessary.