title: Bleeding Dieulafoy lesions of the small bowel: a systematic study on the epidemiology and efficacy of enteroscopic treatment.
abstract: BACKGROUND
  Dieulafoy lesions consist of aberrant submucosal arteries, which can cause severe GI bleeding. The predominant location of Dieulafoy lesions is the upper GI tract.
  
  
  OBJECTIVE
  To our best knowledge, this is the first systematic study on the frequency of bleeding from Dieulafoy lesions in the small bowel and the efficacy of enteroscopic therapy regarding primary hemostasis and long-term follow-up.
  
  
  METHODS
  Multicenter, retrospective, observational study.
  
  
  METHODS
  Nine Austrian centers doing double-balloon enteroscopy or single-balloon enteroscopy.
  
  
  METHODS
  This study involved 284 consecutive patients who were referred for double-balloon enteroscopy or single-balloon enteroscopy because of suspicion of mid-GI bleeding.
  
  
  METHODS
  A total of 317 double-balloon enteroscopy and 78 single-balloon enteroscopy procedures were performed in 284 patients with suspected mid-GI bleeding.
  
  
  METHODS
  Demographic, clinical, procedural, and outcome data were collected.
  
  
  RESULTS
  A Dieulafoy lesion in the small bowel was identified as the source of mid-GI bleeding in 3.5% of patients, with a mean of 1.5 enteroscopy sessions required per diagnosis. In 9 cases the Dieulafoy lesion was found by enteroscopy from an oral approach, and in 1 patient the lesion was found by an anal approach. In all patients primary endoscopic hemostasis was successful. Eight of 10 patients were free from rebleeding episodes (median follow-up 14.5 months, interquartile range 10.0-17.5 months). In 2 of 10 patients, rebleeding occurred, and a surgical intervention was necessary.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Bleeding from Dieulafoy lesions of the small bowel seems to occur more frequently than previously estimated. Most of these lesions are located in the proximal jejunum and can be managed successfully by enteroscopy. After successful endoscopic hemostasis, rebleeding episodes occur in only 20% of patients.
authors.affiliation: Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria.
authors.forename: Emina
authors.initials: E
authors.lastname: Dulic-Lakovic
authors.forename: Melisa
authors.initials: M
authors.lastname: Dulic
authors.forename: Dietmar
authors.initials: D
authors.lastname: Hubner
authors.forename: Harry
authors.initials: H
authors.lastname: Fuchssteiner
authors.forename: Thomas
authors.initials: T
authors.lastname: Pachofszky
authors.forename: Bernhard
authors.initials: B
authors.lastname: Stadler
authors.forename: Andreas
authors.initials: A
authors.lastname: Maieron
authors.forename: Hubert
authors.initials: H
authors.lastname: Schwaighofer
authors.forename: Andreas
authors.initials: A
authors.lastname: Püspök
authors.forename: Thomas
authors.initials: T
authors.lastname: Haas
authors.forename: Gottfried
authors.initials: G
authors.lastname: Gahbauer
authors.forename: Christian
authors.initials: C
authors.lastname: Datz
authors.forename: Parnaz
authors.initials: P
authors.lastname: Ordubadi
authors.forename: Antje
authors.initials: A
authors.lastname: Holzäpfel
authors.forename: Michael
authors.initials: M
authors.lastname: Gschwantler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation; D001158:Arteries / Q000473:pathology*; D058582:Double-Balloon Enteroscopy; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine