Dieulafoy's lesion of the oesophagus: a case series and literature review

Inayat, Faisal; Ullah, Waqas; Hussain, Qulsoom; Hurairah, Abu

doi:10.1136/bcr-2016-218100

Cited by 14 publications

(13 citation statements)

References 22 publications

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“…Although several studies reported a small proportion of extragastric DL [12,14], this location of DL occurred in 43% of our patients. This could be explained by the fact that these are often classified as ulcer disease in the duodenum or vascular malformation in the duodenum or other sites.…”

Section: Discussioncontrasting

confidence: 59%

“…This high value is not surprising due to the high median age of our study population, many with cardiovascular disease. Despite not yet enlightened, some studies defend that nonsteroidal anti-inflammatory drug inducing gastritis with subsequent vessel wall erosion has a role in the pathogenesis of the DL rupture [12]. In our study, 17 patients were medicated with aspirin, and only antiplatelet therapy was a statistically relevant factor in early relapse.…”

Section: Discussionmentioning

confidence: 60%

“…Many series have portrayed effective hemostasis applying a variety of endoscopic modalities, such as injection with cyanoacrylate glue, thermal ablation with a heat probe, monopolar or bipolar probe, and band ligation. The most experienced and described procedure is with sclerosant injection and combination of adrenaline 1: 10,000 and hemoclips [12][13][14][15][16][17][18]. In a meta-analysis by Barakat et al [19], who aim to assess and compare the efficacy of endoscopic band ligation and endoscopic hemoclip placement in achieving primary hemostasis of actively bleeding DL and their rates of rebleeding, the two procedures were effective, achieving primary hemostasis in 91-96% and with few cases of rebleeding (6-17%).…”

Section: Discussionmentioning

confidence: 99%

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

Massinha

Cunha²,

Tomé

2020

GE Port J Gastroenterol

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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.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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

Massinha

Cunha²,

Tomé

2020

GE Port J Gastroenterol

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“…Although endoscopy is the initial investigation of choice for upper gastrointestinal bleeding, only about 30% of cases of hemosuccus pancreaticus can be diagnosed by this procedure. Endoscopic evaluation is of prime importance to exclude more common causes of upper gastrointestinal hemorrhage, including acute erosive gastritis, peptic ulcer disease, and esophageal and gastric fundus varices as well as relatively uncommon causes like Dieulafoy’s lesion [11-13]. Advanced endoscopic techniques such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are utilized for better visualization of the source of bleeding [14].…”

Section: Discussionmentioning

confidence: 99%

Hemosuccus Pancreaticus: A Great Masquerader in Patients with Upper Gastrointestinal Bleeding

Inayat

Ali

Khan

et al. 2018

Cureus

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Hemosuccus pancreaticus is a rare but life-threatening cause of upper gastrointestinal bleeding through the main pancreatic duct. This clinical entity is a difficult diagnosis due to its rarity, intermittent nature of the hemorrhage, and peculiar clinical presentation. It is still considered a surgical problem but advances in medical therapy may enable clinically stable patients to undergo less-invasive angiographic embolization. We chronicle here a unique case of hemosuccus pancreaticus in a patient presenting with melena who could not be diagnosed on multiple standard forward-viewing esophagogastroduodenoscopies and computed tomography angiography. Eventually, side-viewing duodenoscope identified the intermittent bleeding through the ampulla of Vater. This paper illustrates that clinicians should be vigilant for this etiology, especially in patients with intermittent crescendo-decrescendo abdominal pain, acute gastrointestinal hemorrhage, and elevated serum lipase levels. A multidisciplinary team approach with the centralization of gastrointestinal bleed services and a well-established management protocol is of paramount importance to reduce the morbidity and mortality of this disorder. Additionally, this article serves to outline our current understanding of the epidemiology of and risk factors for hemosuccus pancreaticus, the pathophysiology of this disease, and currently available approaches to diagnosis and treatment.

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“…Over 70% of all lesions occur in the proximal stomach and 80-95% of gastric lesions are located close to the gastroesophageal junction (3). Moreover, less than 35% of all the cases involve extragastric sites, with duodenum (15%), esophagus (8%), colon (2%), and jejunoileal lesions making up less than 1% (4)(5)(6). This disease has a predilection for males in their fifth and sixth decades of life, with the overall male-to-female ratio of 2:1 (6).…”

Section: Introductionmentioning

confidence: 99%

Rectal Dieulafoy’s lesion: a comprehensive review of patient characteristics, presentation patterns, diagnosis, management, and clinical outcomes

Inayat¹,

Hussain²,

Yahya³

et al. 2022

Transl Gastroenterol Hepatol

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Dieulafoy's lesion is an abnormally large, tortuous, submucosal vessel that erodes the overlying mucosa, without primary ulceration or erosion. Although these lesions predominantly involve the stomach and upper small intestine, they are being detected with increasing frequency in the rectum. We conducted a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases for adult rectal Dieulafoy's lesion. After careful review of the search results, a total of 101 cases were identified. The data on patient characteristics, clinical features, colonoscopy findings, diagnosis, treatment, and clinical outcomes were collected and analyzed. The mean age of presentation was 66±17 years (range, 18-94 years), with 54% of cases reported in males. Clinical presentation was dominated by acute lower gastrointestinal bleeding in the form of bright-red blood per rectum 47% and hematochezia 36%, whereas 16% of patients were admitted with symptoms related to other medical conditions. Major underlying disorders were hypertension 29%, diabetes mellitus 21%, and chronic kidney disease 16%. The average number of colonoscopies required for the diagnosis of rectal Dieulafoy's lesion was 1.5±0.7. In regard to treatment, endoscopic therapy was applied in 80%, direct surgical suturing in 12%, angiographic embolization in 4%, and endoscopic therapy followed by surgical ligation was performed in 4% of patients. The endoscopic treatment was a feasible choice for rectal disease, with a primary hemostasis rate of 88%. Although the overall mortality rate was 6%, the causes of death were unrelated to this entity. This review illustrates that patients with rectal Dieulafoy's lesion can have a favorable clinical outcome. Prompt diagnosis and appropriate management are of paramount importance to prevent serious hemodynamic complications. The best therapeutic modality remains to be determined but the data presented here support the use of mechanical endoscopic methods as safe and effective.

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Dieulafoy's lesion of the oesophagus: a case series and literature review

Cited by 14 publications

References 22 publications

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

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

Hemosuccus Pancreaticus: A Great Masquerader in Patients with Upper Gastrointestinal Bleeding

Rectal Dieulafoy’s lesion: a comprehensive review of patient characteristics, presentation patterns, diagnosis, management, and clinical outcomes

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