[UPPER GASTROINTESTINAL BLEEDING RELATED TO DIEULAFOY LESION]
Dieulafoy lesion is an unsual source of upper astrointestinal bleeding with a frequency ranging from 0.3 to 6.7% of the reported literature, although at present it is more frequently diagnosed. It usually begins abruptly with massive bleeding and hemodynamic involvement. The higher prevalence is found in older people and because this group of patients is generally affected by other diseases, Dieulafoy lesion may be life threatening. A thick arterial blood vessel flows through the mucosa and submucosa and in more than 75% of cases the lesion is mostly found within 6 cm of the cardia. The severity of bleeding and the site of the lesion render the diagnosis sometimes difficult, more than one endoscopic exam is often required.There are different types of endoscopic treatment but combined methods seem to be the consense, epinephrine injection followed by thermal coagulation, rubber banding, or recently, hemoclips is being reported. The injection of sclerosing agents is also useful as has been published in later reports. The treatment must be aggressive to obliterate the bleeding vessel. The rate of complications reported with endoscopic approach, mainly perforation, is very low.Initial hemostasis is accomplished in 82% to 96% of cases and a complete one is achieved in 60% to 91% of the events. Recurrence can be treated in the same way as the first episode, but frequently massive bleeding or failure of an initial attempt to obliterate the vessel makes surgery mandatory. The prevalence rate of surgical treatment is between 2% to 36%, being local excision a better approach than the simple suture of the lesion. Before endoscopic age, the mortality rate was as high as 80% but it has been reduced, values range now from 0% to 22%. Long term follow - up after an initial successful endoscopic procedure has decreased the incidence of recurrency of the bleeding episode, being at present as low as 0% to 4.7%
Contardo
Carlos
C