title: Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy's lesion.
abstract: OBJECTIVE
  To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding.
  
  
  METHODS
  Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy's lesion (DL) from 2005 to 2011. We analyzed the demographic characteristics of the patients, risk factors for gastrointestinal bleeding, endoscopic findings, characteristics of the endoscopic treatment, and the recurrence of bleeding. We included cases in which endoscopy described a lesion compatible with Dieulafoy. We excluded patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures.
  
  
  RESULTS
  Twenty-nine patients with DL were identified. Most of them were men with an average age of 71.5 years. Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy. The most common location for DL was the stomach (51.7%). The main type of bleeding was oozing in 65.5% of cases. In 27.6% of cases, there was arterial (spurting) bleeding, and 6.9% of the patients presented with an adherent clot. A single endoscopic treatment was applied to nine patients (31%); eight of them with adrenaline and one with argon, while 69% of the patients received combined treatment. Six patients (20.7%) presented with recurrent bleeding at a median of 4 d after endoscopy (interquartile range = 97.75). Within these six patients, the new endoscopic treatment obtained a therapeutic success of 100%. The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding (50% vs 33.3% for other type of bleeding) [P = 0.024, odds ratio (OR) = 8.5, 95% CI = 1.13-63.87]. The use of combined endoscopic treatment prevented the recurrence of bleeding (10% vs 44.4% of single treatment) (P = 0.034, OR = 0.14, 95% CI = 0.19-0.99).
  
  
  CONCLUSIONS
  Endoscopic treatment of DL is safe and effective. Adrenaline monotherapy and arterial (spurting) bleeding are associated with a high rate of bleeding recurrence.
authors.affiliation: Department of Digestive System, University Hospital of Salamanca, 37007 Salamanca, Spain.
authors.forename: Yuliana
authors.initials: Y
authors.lastname: Jamanca-Poma
authors.forename: Antonio
authors.initials: A
authors.lastname: Velasco-Guardado
authors.forename: Concepción
authors.initials: C
authors.lastname: Piñero-Pérez
authors.forename: Renzo
authors.initials: R
authors.lastname: Calderón-Begazo
authors.forename: Josue
authors.initials: J
authors.lastname: Umaña-Mejía
authors.forename: Fernando
authors.initials: F
authors.lastname: Geijo-Martínez
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Pérez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D016558:Hemostasis, Endoscopic; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications* / Q000175:diagnosis