Hemostasis of Dieulafoy's lesions by argon plasma coagulation (with video).
BACKGROUND
A Dieulafoy's lesion is a submucosal artery that may erode the epithelium and lead to severe hemorrhages. The safety and efficacy of argon plasma coagulation (APC) for the hemostasis of these lesions has not been studied.


OBJECTIVE
To evaluate efficacy of APC alone in the hemostasis of Dieulafoy's lesions.


METHODS
A retrospective analysis of hemostasis by chart review, with long-term follow-up by outpatient visit or phone interview.


METHODS
An academic hospital with 24-hour endoscopic service availability.


METHODS
All patients with acute bleeding from a Dieulafoy's lesion treated with APC.


METHODS
Hemostasis was attempted with 2.3-mm APC probes, with settings varying from 40 W to 60 W, according to lesion location.


METHODS
Initial hemostasis, recurrent bleeding, and 30-day mortality rates.


RESULTS
Twenty-three Dieulafoy's lesions were treated with APC, which represented 85% of all such lesions observed. Severe comorbidities and abnormal coagulation were present in 39% and 22%, respectively. Dieulafoy's lesions were located in the upper-GI tract in 20 patients (87%). Active bleeding was found in 20 patients (87%), a nonbleeding visible vessel was found in 2 patients (9%), and a minute mucosal defect below an adherent clot was found in 1 (4%). Initial hemostasis was achieved in all patients, without complications. An injection of an average volume of 3 mL of 1:10,000 epinephrine solution preceded APC in 3 cases for the identification of the bleeding lesion. Recurrent bleeding occurred in a patient after 48 hours; no bleeding-related deaths were observed during a median follow-up of 29 months.


CONCLUSIONS
Retrospective study.


CONCLUSIONS
Dieulafoy's lesions can be successfully managed by APC alone.
Iacopini
Federico
F
Digestive Endoscopy Unit, Department of Surgery, Catholic University, Rome, Italy.
Petruzziello
Lucio
L
Marchese
Michele
M
Larghi
Alberto
A
Spada
Cristiano
C
Familiari
Pietro
P
Tringali
Andrea
A
Riccioni
Maria Elena
ME
Gabbrielli
Armando
A
Costamagna
Guido
G
D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000002:abnormalities*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000098:blood supply*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome