Recurrent Gastrointestinal Bleeding from Dieulafoy’s Lesions in a Patient with Type 1 von Willebrand Disease: A Rare Association

Cardoso, Mariana Ferreira; Lourenço, Luís Carvalho; Antunes, Mónica; Branco, Joana C.; Santos, Liliana; Martins, Alexandra; Reis, Jorge

doi:10.1159/000490921

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…74 After accurate identification, the lesion site should also be tattooed using India ink to mark it for recurrence or possible presence of more than one Dieulafoy's lesions. 33,75 In this review, most lesions were identified in the proximal jejunum (64%), followed by the distal (24%) and middle parts (13%). In addition, the lesion was also noted in the jejunal side of the anastomotic sites in some cases.…”

Section: Comorbid Conditionsmentioning

confidence: 80%

Jejunal Dieulafoy’s Lesion: A Systematic Review of Evaluation, Diagnosis, and Management

Malik

Inayat

Goraya

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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Jejunal Dieulafoy’s lesion is an exceedingly rare but important cause of gastrointestinal bleeding. It frequently presents as a diagnostic and therapeutic conundrum due to the rare occurrence, intermittent bleeding symptoms often requiring prompt clinical action, variability in the detection and treatment methods, and the risk of rebleeding. We performed a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases regarding jejunal Dieulafoy’s lesio from inception till June 2020. A total of 136 cases were retrieved from 76 articles. The mean age was 55 ± 24 years, with 55% of cases reported in males. Patients commonly presented with melena (33%), obscure-overt gastrointestinal bleeding (29%), and hemodynamic compromise (20%). Hypertension (26%), prior gastrointestinal surgery (14%), and valvular heart disease (13%) were the major underlying disorders. Conventional endoscopy often failed but single- and double-balloon enteroscopy identified the lesion in 96% and 98% of patients, respectively. There was no consensus on the treatment. Endoscopic therapy was instituted in 64% of patients. Combination therapy (34%) with two or more endoscopic modalities, was the preferred approach. With regard to endoscopic monotherapy, hemoclipping (19%) and argon plasma coagulation (4%) were frequently employed procedures. Furthermore, direct surgical intervention in 32% and angiographic embolization was performed in 4% of patients. The rebleeding rate was 13.4%, with a mean follow-up duration of 17.6 ± 21.98 months. The overall mortality rate was 4.4%. Jejunal Dieulafoy’s lesion is still difficult to diagnose and manage. Although the standard diagnostic and therapeutic modalities remain to be determined, device-assisted enteroscopy might yield promising outcomes.

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Section: Comorbid Conditionsmentioning

confidence: 80%

Jejunal Dieulafoy’s Lesion: A Systematic Review of Evaluation, Diagnosis, and Management

Malik

Inayat

Goraya

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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“…Our search identified 10,019 unique studies. After screening by title and abstract, and full‐text review, 61 studies were included in the review of which 54 had patient‐level data comprising 146 patients 8,10,15–66 and nine reported data usable at the population or survey level 9,11,19,51,67–71 (Figure 1). There were no new studies for inclusion identified by review of reference lists.…”

Section: Resultsmentioning

confidence: 99%

Vascular abnormalities in patients with von Willebrand disease: A scoping review

Chornenki

Shanjer

James

2021

Journal of Thrombosis and Haemostasis

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Background: Qualitative or quantitative defects of von Willebrand factor (VWF) such as in von Willebrand disease (VWD) are associated with vascular abnormalities, especially in the gastrointestinal (GI) tract. However, the locations, extent, and natural history of vascular abnormalities in patients with VWD is not well understood. To summarize the existing literature on the topic, we conducted a scoping review of vascular abnormalities in patients with VWD. Methods:We searched MEDLINE and EMBASE from inception to September 1, 2020, for studies clinically describing vascular abnormalities in VWD patients. Screening and data extraction was completed independently and in duplicate and each abnormality was documented individually.Results: After screening, 54 studies that reported patient level data comprising 146 patients were included. Type 2A (39%) and type 3 (14.4%) were the most common VWD subtypes. The most common site of vascular malformation was the GI tract, occurring in 124 patients (84.9%), whereas 18 (12.3%) had non-GI vascular abnormalities and 4 (2.7%) had both GI and non-GI vascular abnormalities. With respect to outcomes, the clinical course was not specified in the majority (55.5%) of patients.Survey and population level data were reported in nine studies, demonstrating vascular abnormalities occurred at higher rates in VWD and that VWD patients are overrepresented among those with those abnormalities. Conclusion:Vascular malformations in patients with VWD occur primarily in the gastrointestinal tract. Type 2A and type 3 VWD are the most common subtypes affected.The clinical treatment and natural history of these abnormalities remains understudied and further research is needed.

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“…Currently, with the innovation of balloon-assisted endoscopy (BAE), DL is generally thought to be an acquired condition, mainly because they have been historically more common among the elderly. In the study by Cardoso MF et al [14], the authors suggested that DL occurred more frequently among males and in the setting of comorbidities such as cardiopulmonary dysfunction and chronic kidney disease. Several hypotheses have been put forward to explain bleeding from DLs.…”

Section: Introductionmentioning

confidence: 99%

“…Several hypotheses have been put forward to explain bleeding from DLs. The use of aspirin, warfarin, or nonsteroidal antiin ammatory drugs has been reported in some patients who experience bleeding from DLs [15]; however, no causal link has been established [14,16].…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of Dieulafoy’s Lesion in the Small Bowel Diagnosed and Treated by Double-Balloon Endoscopy

Nakamura

Yamamura

Maeda

et al. 2023

Preprint

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BACKGROUNDS Obscure gastrointestinal bleeding indicates bleeding in which the source cannot be determined even by balloon-assisted endoscopy. In some cases, the cause is assumed to be a Dieulafoy’s lesion in the small bowel. AIM This retrospective study aimed to reveal the clinical characteristics of Dieulafoy’s lesion in the small bowel as diagnosed by double-balloon endoscopy and consider whether it is possible to predict bleeding from Dieulafoy’s lesionbefore endoscopy in obscure gastrointestinal bleeding. METHOD We reviewed the database of our hospital and identified 38 patients who were diagnosed with Dieulafoy’s lesion and underwent treatment during double-balloon endoscopy. The clinical background, diagnosis, and treatment details of patients with Dieulafoy’s lesion were examined. RESULTS The median age of the 38 patients was 72 years, and 50% of the patients were male. Of the patients, 26 (68%) had a high comorbidity index. We analyzed whether the first double-balloon endoscopy could be definitely diagnosed. Multivariate analysis revealed that hematochezia of ≥ 2 episodes was the independent factor associated with ≥ 2 double-balloon endoscopy diagnoses. The factors associated with re-bleeding after endoscopic treatment were analyzed. Multivariate analysis did not reveal any independent factor associated with re-bleeding, although the number of hemoclips used was likely to be associated. CONCLUSION In cases where a patient experiences two or more episodes of hematochezia, balloon-assisted endoscopy, prepared with optional devices, should be scheduled at the earliest possible time.

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Recurrent Gastrointestinal Bleeding from Dieulafoy’s Lesions in a Patient with Type 1 von Willebrand Disease: A Rare Association

Cited by 5 publications

References 19 publications

Jejunal Dieulafoy’s Lesion: A Systematic Review of Evaluation, Diagnosis, and Management

Jejunal Dieulafoy’s Lesion: A Systematic Review of Evaluation, Diagnosis, and Management

Vascular abnormalities in patients with von Willebrand disease: A scoping review

Clinical characteristics of Dieulafoy’s Lesion in the Small Bowel Diagnosed and Treated by Double-Balloon Endoscopy

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