Dieulafoy Lesion: Predictive Factors of Early Relapse and Long-Term Follow-Up

Abstract

Introduction: The Dieulafoy lesion (DL) is a rare cause of gastrointestinal bleeding. Advances in the endoscopy field have allowed an increased rate of detection and therapeutic efficacy. However, doubts remain about the most effective hemostatic approach, the affecting variables of therapeutic failure, and early relapse, as well as in the long-term followup. Aims: To assess the efficacy of endoscopic treatment of DL and to identify possible risk factors for early relapse and long-term results. Methods: All patients with DL admitted to a tertiary hospital between 01/01/2007 and 12/31/2018 were evaluated. The form of presentation, associated pathologies, chronic medication, therapeutic approach, and eventual relapse were determined. A telephone interview was conducted for all patients to find out the long-term results. Results: We identified 73 patients with DL, 45 (61.6%) males, with a mean age of 74 ± 15 years. Thirty-nine patients presented the DL in the stomach, 15 in the duodenum, 2 in the small bowel, 3 in the colon, and 11 in the rectum. The median number of endoscopic examinations required for di-agnosis was 2. Median Rockall was 4 (range 2-7). After endoscopic treatment, in 95% of the cases, no active bleeding was evident. Only 2 patients required interventional radiology procedures and 1 needed surgery. Fourteen patients (19%) had a rebleeding, 12 during hospitalization and 2 after a median time of 51 months (range 1-117). There was no difference between the groups with and without early relapse in relation to age, gender, hemoglobin values at presentation, presence of shock, associated pathologies, and anticoagulation. Antiplatelet agents intake had a statistically significant relationship with early relapse (p = 0.003). Conclusion: Endoscopic therapy is safe and effective in DL. Patients under antiplatelet therapy are more likely to have an early relapse. The long-term prognosis is excellent, even in patients only treated with endoscopic methods.

Duodenal Dieulafoy lesion: a rare pathogeny of gastrointestinal bleeding in children

“…With the continuous development of endoscopic and interventional techniques, surgery is mainly used as the choice after endoscopy or interventional treatment fails, while laparoscopic exploration can be used as the preferred surgical method. 8,9 The surgical exploration of this case failed, which was a profound lesson for us. We hope to provide experiences for other researchers with the solution of the appropriate problem and the addition of the lessons learned.…”

Lesión de Dieulafoy

“…(Soriaet al; 2018; pág. 374) Massinha et al (2020) explican que la LD se trata de un brote de la "arteria inusualmente grande y tortuosa" (pág. 238) que se extiende a lo largo de la muscularis mucosa del tracto gastrointestinal, y que mayormente se presenta en el estómago proximal.…”

Massively bleeding Dieulafoy lesion and unique rescue: a video based case report from National Liver Institute, Menoufia University

“…Pure injection endoscopic management, leukocytosis, reduced prothrombin concentration and the use of antiplatelet drugs have been mentioned in many studies as predictors for rebleeding of Dieulafoy lesion after first endoscopic hemostasis [18,19].…”