Dieulafoys lesion is a vascular lesion that is widely recognized as a persistently en− gorged, tortuous artery in the muscularis mucosa which is not associated with in− flammation or atherosclerosis. The inci− dence of this lesion in patients with upper gastrointestinal bleeding has been estima− ted to be between 0.3 % and 6.7 %. Clinical− ly, these lesions manifest as massive gas− trointestinal hemorrhage, with no preced− ing symptoms. If the lesion is not treated, patients continue to bleed intermittently over the following days [1]. The advent of therapeutic endoscopic management has resulted in significantly improved out− comes. Success rates between 75 % and 96 % have been reported for endoscopic in− tervention [1 ± 3]. As a result, endoscopic management has replaced surgery as the gold standard for the diagnosis and treat− ment of Dieulafoy lesions.We read with great interest the article by Romozinho et al. [4] which described the clinical pattern and reported the long− term outcome in 70 patients admitted for acute upper gastrointestinal bleeding due to Dieulafoys lesion. Endoscopic hemo− stasis was initially successful in 63 pa− tients (91 %); 11 patients (16 %) required surgery because of eventual failure of en− doscopic therapy. A total of 52 patients were followed up for between 32 months and 137 months after discharge from hos− pital and no further bleeding was noted. These results suggest that the long−term prognosis for Dieulafoys lesion is excel− lent, even when patients are treated using endoscopic therapies alone.The last four patients we admitted with acute upper gastrointestinal bleeding due to Dieulafoys lesion have been treat− ed with injection therapy and band liga− tion (two or three bands) ( Figure [1], [2]) and no complications were noted after treatment. One experienced recurrent bleeding on day 5 after injection therapy alone. These patients have been followed up for between 12 months and 16 months and no further bleeding has been noted. Based on a recent study [3] and on our own experience, we would like to briefly review the current position and our con− clusions on the endoscopic treatment of bleeding Dieulafoy lesions.The first mode of therapy advocated for bleeding Dieulafoy lesions was surgery, which was associated with high mortality and morbidity (related to the emergency subtotal gastrectomy). The advent of en− doscopy significantly improved the diag− nosis of Dieulafoys lesion and offered safe and effective therapeutics options [1 ± 4]. Based on the results described above and elsewhere, we concur that en− doscopic therapies are now the first and the best option in the management of Dieulafoys lesion.There are now some data on the relative efficacies of different endoscopic treat− ment modalities in patients with bleeding Dieulafoys lesion. Chung et al. [2] found that mechanical treatment (hemoclip and band ligation) successfully achieved primary hemostasis in 91.7 % of patients, compared with a primary hemostasis rate of 75 % in patients treated with injec− tion therapy alo...
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