Bleeding from Dieulafoy's lesion: diagnostic and therapeutic trends

Abstract

Introduction. Dieulafoy’s lesion (DL) is a rare, potentially life-threating cause of gastrointestinal hemorrhage, which is characterized by the presence of a unusual large tortuous artery with in the submucosal layer. The lesion predominantly occurs in the proximal stomach (80%), 6cm from the gastroesophageal junction along the lesser curvature. However, it may occur in any part of the gastrointestinal (GI) tract. Extragastric localization are also described in the literature. Aim of the study. To offer an overview of current data on available diagnostic and therapeutic tools used for patients with GI bleeding resulting from DLs. Materials and methods. We selected the articles published during the years 2015-2020, from the PubMed database according to the following keywords:,,Gastrointestinal bleeding", „Arteriovenous malformation”, „Dieulafoy’s lesion”, „Endoscopic hemostasis” . Results. According to the latest statistics, DL is responsible for up to 5% of acute GI bleeds. Typically, it occurs in middle-aged men, and can vary from self-limited to massive lifethreatening hemorrhage. Esophagogastroduodenoscopy may significantly improve the recognition and management of this pathology. Mechanical hemostatic therapies including endo-clipping and endoscopic band ligation are considered the most effective techniques in controlling bleeding than other endoscopic methods. Pharmacological treatment can be indicated for patients in which endoscopy is contraindicated or for those who are not responding well to other treatments. Surgical resection is reserved for the cases that fail conservative interventions.Conclusions. Due to large implementation of endoscopic investigations DLs are increasingly identified. Elaboration of standardized diagnostic and therapeutic protocols may improve the treatment quality.