Gastrointestinal bleeding from Dieulafoy＇s lesion： Clinicalpresentation, endoscopic findings, and endoscopic therapy

• 作者: Borko Nojkov Mitchell S Cappell
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Dieulafoy's LESION GASTROINTESTINAL BLEEDING
• 年，卷（期）: 2015,（4）
• 页码范围: 295-307
• 页数: 13页
• 分类号: R

摘要

Although relatively uncommon, Dieulafoy＇s lesion is animportant cause of acute gastrointestinal bleeding dueto the frequent difficulty in its diagnosis; its tendency tocause severe, life-threatening, recurrent gastrointestinalbleeding; and its amenability to life-saving endoscopictherapy. Unlike normal vessels of the gastrointestinaltract which become progressively smaller in caliberperipherally, Dieulafoy＇s lesions maintain a large caliberdespite their peripheral, submucosal, location withingastrointestinal wall. Dieulafoy＇s lesions typicallypresent with severe, active, gastrointestinal bleeding,without prior symptoms; often cause hemodynamicinstability and often require transfusion of multipleunits of packed erythrocytes. About 75% of lesionsare located in the stomach, with a marked proclivity oflesions within 6 cm of the gastroesophageal junctionalong the gastric lesser curve, but lesions can alsooccur in the duodenum and esophagus. Lesions inthe jejunoileum or colorectum have been increasinglyreported. Endoscopy is the first diagnostic test, but hasonly a 70% diagnostic yield because the lesions arefrequently small and inconspicuous. Lesions typicallyappear at endoscopy as pigmented protuberances fromexposed vessel stumps, with minimal surrounding erosionand no ulceration （visible vessel sans ulcer）. Endoscopictherapy, including clips, sclerotherapy, argon plasmacoagulation, thermocoagulation, or electrocoagulation,is the recommended initial therapy, with primary hemostasisachieved in nearly 90% of cases. Dual endoscopictherapy of epinephrine injection followed by ablative ormechanical therapy appears to be effective. Althoughbanding is reportedly highly successful, it entails asmall risk of gastrointestinal perforation from bandingdeep mural tissue. Therapeutic alternatives after failedendoscopic therapy include repeat endoscopic therapy,angiography, or surgical wedge resection. The mortalityhas declined from about 30% during the 1970＇s to9%-13% currently with the advent of aggressive endoscopict