Endoscopy 2018; 50(04): S8
DOI: 10.1055/s-0038-1637047
ESGE Days 2018 oral presentations
20.04.2018 – GI bleeding
Georg Thieme Verlag KG Stuttgart · New York

DIEULAFOY'S LESION: CLINICAL AND EPIDEMIOLOGICAL ANALYSIS OF AN UNCOMMON CAUSE OF GASTROINTESTINAL HEMORRHAGE

D João Matias
1   Complejo Asistencial Universitario de León, Gastroenterology Department, León, Spain
,
L Monteserin Ron
2   Hospital Clínico Universitario de Santiago, Gastroenterology Department, Santiago de Compostela, Spain
,
L Vaquero Ayala
1   Complejo Asistencial Universitario de León, Gastroenterology Department, León, Spain
,
N Fernández Fernández
3   Hospital Álvaro Cunqueiro, Gastroenterology Department, Vigo, Spain
,
S Vivas Alegre
1   Complejo Asistencial Universitario de León, Gastroenterology Department, León, Spain
,
L Rodríguez Martín
1   Complejo Asistencial Universitario de León, Gastroenterology Department, León, Spain
,
F Jorquera Plaza
1   Complejo Asistencial Universitario de León, Gastroenterology Department, León, Spain
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Publikationsdatum:
27. März 2018 (online)

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    Aims:

    To analyse the characteristics, risk factors, treatment and evolution associated to Dieulafoy's lesion.

    Methods:

    Retrospective study from January 2000 to December 2013 of patients who underwent endoscopy resulting in Dieulafoy's diagnosis. We have evaluated epidemiological varies, clinical presentation, risk factors, treatment and clinical outcome.

    Results:

    We gathered data from 77 patients, medium age 74 years, 52% males. Dieulafoy's lesion supposed 1.4% of gastrointestinal bleeding cases admitted at our centre in this period. The most frequent locations were gastric (57%), duodenal (30%) and colon (12%). The most common clinical presentation was melena (38%), followed by hematemesis (34%) and rectal bleeding (10%). The medium haemoglobin levels at diagnosis were 8.2 g dl and average admission was 8.4 days. The most prevalent risk factors were hypertension (60%), cardiovascular disease (53%), diabetes mellitus (31%) and paroxysmal atrial fibrillation (26%). One third of the patients had history of antiplatelet use, 28% were under anticoagulants and less than a half of them used proton pump inhibitors (PPI) (46%). 40% of the patients needed more than one endoscopy for diagnosis. The treatment most commonly used was sclerosis+hemoclip (39%), needing a second session in 26% of the cases. Moreover, 70% of the patients needed blood transfusion (average 3.26 units per patient). The recurrence was 18%. 9.77 patients deceased (11.7%), all with history of upper GI bleeding. According to location, the colon and duodenum lesions were higher among women and gastric among men (p < 0.05). Colon lesions were associated in higher proportion with coronary heart disease (p < 0.05). Duodenal lesions debuted with more anaemia (p < 0.05), more transfusional needs (p < 0.01), more blood units per patient (p < 0.05) and greater recurrence (p < 0.05).

    Conclusions:

    Dieulafoy's lesion, nevertheless its low incidence, presents important morbimortality, with high transfusion rate. It is associated with cardiovascular disease. The duodenal location is the one with greatest repercussion. Even though there were amazing endoscopic advances, Dieulafoy's lesion is still a diagnostic and therapeutic challenge nowadays.


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