Dieulafoy's lesion: a case series study.
OBJECTIVE
Dieulafoy's lesion (DL) accounts for 1-5.8% of cases of acute upper gastrointestinal bleeding (GIB). Its mortality is high, approaching 20%, despite recent advances in endoscopic therapy. We aimed to report our experience in the treatment of DL.


METHODS
A retrospective case study of all patients with DL between January 1993 and January 2003 was done. Characteristics, treatment methods, success rates and 30-d mortality of the patients were analyzed.


RESULTS
Thirty-six patients were noted to have DL in the study period. Thirty-three records were available for assessment in which 35 DL were identified. The median age of the patients was 67 years with male to female ratio of 5.6:1. Significant comorbidities existed in 69% of the patients. Eighty-nine percent of the DL was found at first endoscopy, three DL at laparotomy. Significant coexistent endoscopic findings existed in 23%. Hemostasis was achieved in 88% by using adrenaline injection, or in combination with heater probe application at first endoscopy. Four cases had re-bleeding, all were successfully treated endoscopically. The 30-d mortality rate was 23%.


CONCLUSIONS
Successful endoscopic hemostasis could be achieved in 100% of cases of DL. The overall mortality may still remain high, mainly due to the comorbidities and age of these patients.
Walmsley
R S
RS
Department of Gastroenterology, North Shore Hospital, Shakespeare Road, Private Bag 93-503, Takapuna, Auckland, New Zealand. russell.walmsley@waitematadhb.govt.nz
Lee
Yuk-Tong
YT
Sung
Joseph J Y
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome