title: Endoscopic Management of Dieulafoy's Lesion.
abstract: A Dieulafoy's lesion is a vascular abnormality consisting of a large caliber-persistent tortuous submucosal artery. A small mucosal defect with the eruption of this protruding vessel can cause bleeding. In fact, a Dieulafoy's lesion is a relatively rare but potentially life-threatening condition. It accounts for 1% to 2% of cases of acute gastrointestinal bleeding. Although there is no consensus on the treatment of Dieulafoy's lesions; treatment options depend on the mode of presentation, site of the lesion, and available expertise. Endoscopic therapy is usually successful in achieving primary hemostasis, with hemostasis success rates reaching 75% to 100%. Although various therapeutic endoscopic methods are used to control bleeding in Dieulafoy's lesions, the best method for endoscopic intervention is not clear. Combination endoscopic therapy is known to be superior to monotherapy because of a lower rate of recurrent bleeding. In addition, mechanical therapies including hemostatic clipping and endoscopic band ligation are more effective and successful in controlling bleeding than other endoscopic methods. Advances in endoscopic techniques have reduced mortality in patients with Dieulafoy's lesion-from 80% to 8%-and consequently, the need for surgical intervention has been reduced. Currently, surgical intervention is used for cases that fail therapeutic endoscopic or angiographic interventions.
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
keywords: Dieulafoy's lesion; Endoscopic treatment; Gastrointestinal tract
references.citation: Tohoku J Exp Med. 1988 Feb;154(2):135-41
references.pmid: 3289138
references.citation: Am J Gastroenterol. 1984 Mar;79(3):195-200
references.pmid: 6199971
references.citation: Ann R Coll Surg Engl. 2010 Oct;92(7):548-54
references.pmid: 20883603
references.citation: Gastrointest Endosc. 2000 Dec;52(6):721-4
references.pmid: 11115902
references.citation: Korean J Intern Med. 2009 Dec;24(4):318-22
references.pmid: 19949729
references.citation: J Pediatr Surg. 2004 Nov;39(11):1726-8
references.pmid: 15547843
references.citation: Gastrointest Endosc. 1996 Oct;44(4):437-42
references.pmid: 8905365
references.citation: Clin Endosc. 2014 Jul;47(4):315-9
references.pmid: 25133117
references.citation: J Pediatr Surg. 2009 Feb;44(2):441-3
references.pmid: 19231553
references.citation: J R Coll Surg Edinb. 1999 Aug;44(4):222-5
references.pmid: 10453143
references.citation: World J Gastroenterol. 2005 Oct 14;11(38):6022-6
references.pmid: 16273618
references.citation: J Clin Gastroenterol. 2003 Apr;36(4):310-4
references.pmid: 12642736
references.citation: BMC Gastroenterol. 2003 Jan 31;3:2
references.pmid: 12581456
references.citation: Arch Pathol Lab Med. 2006 Feb;130(2):e27-9
references.pmid: 16454577
references.citation: World J Gastroenterol. 2005 Jun 21;11(23):3574-7
references.pmid: 15962378
references.citation: Gastrointest Endosc Clin N Am. 1996 Oct;6(4):739-52
references.pmid: 8899405
references.citation: Gastrointest Endosc. 2003 Aug;58(2):236-43
references.pmid: 12872092
references.citation: Endoscopy. 2005 May;37(5):449-53
references.pmid: 15844024
references.citation: Gastrointest Endosc. 2003 May;57(6):653-6
references.pmid: 12709692
references.citation: Gut. 1986 Feb;27(2):213-22
references.pmid: 3485070
references.citation: Gastrointest Endosc. 1999 Dec;50(6):762-7
references.pmid: 10570333
references.citation: Am J Gastroenterol. 1990 Apr;85(4):452-4
references.pmid: 2248637
references.citation: Turk J Gastroenterol. 2007 Dec;18(4):265-7
references.pmid: 18080926
references.citation: Gastrointest Endosc. 2007 Jul;66(1):162-7
references.pmid: 17591492
references.citation: Am J Gastroenterol. 2001 Jun;96(6):1688-94
references.pmid: 11419815
references.citation: Dig Dis Sci. 2004 Aug;49(7-8):1139-44
references.pmid: 15387335
references.citation: Dig Dis Sci. 1991 Dec;36(12):1702-7
references.pmid: 1748038
references.citation: Case Rep Gastrointest Med. 2012;2012:186065
references.pmid: 23050173
references.citation: Surg Endosc. 2009 Jul;23(7):1465-9
references.pmid: 19125307
references.citation: Endoscopy. 2001 Sep;33(9):754-60
references.pmid: 11558028
references.citation: Hepatogastroenterology. 2006 Mar-Apr;53(68):224-7
references.pmid: 16608029
references.citation: World J Gastroenterol. 2012 Oct 28;18(40):5734-8
references.pmid: 23155314
references.citation: Dis Colon Rectum. 2004 Sep;47(9):1539-43
references.pmid: 15486754
references.citation: Diagn Interv Radiol. 2006 Sep;12 (3):151-4
references.pmid: 16972222
references.citation: Can J Gastroenterol. 2006 Apr;20(4):287-90
references.pmid: 16609760
references.citation: Endoscopy. 1997 Nov;29(9):834-9
references.pmid: 9476766
references.citation: Dig Dis Sci. 2010 Dec;55(12):3436-41
references.pmid: 20848205
references.citation: Gastrointest Endosc. 2008 Dec;68(6):1128-30
references.pmid: 19028221
references.citation: World J Gastroenterol. 2006 Jun 28;12(24):3936-7
references.pmid: 16804987
references.citation: Gastrointest Endosc. 2002 Feb;55(2):214-8
references.pmid: 11818925
references.citation: Endoscopy. 2004 Aug;36(8):677-81
references.pmid: 15280971
references.citation: Gastrointest Endosc. 2001 Nov;54(5):623
references.pmid: 11677481
references.citation: Indian J Gastroenterol. 2005 May-Jun;24(3):114-5
references.pmid: 16041104
references.citation: Gastroenterology. 1988 Mar;94(3):563-6
references.pmid: 3257449
references.citation: Gastrointest Endosc. 2002 Apr;55(4):527-31
references.pmid: 11923766
references.citation: Dis Colon Rectum. 1999 Oct;42(10):1339-41
references.pmid: 10528775
references.citation: Arch Pathol Lab Med. 2009 Nov;133(11):1865-7
references.pmid: 19886725
references.citation: Gastrointest Endosc. 1994 Jul-Aug;40(4):501-3
references.pmid: 7926548
references.citation: Gastrointest Endosc. 2007 Jul;66(1):20-6
references.pmid: 17591469
references.citation: Gastrointest Endosc. 2012 Jan;75(1):32-8
references.pmid: 22100302
references.citation: Endoscopy. 2006 Feb;38(2):193-4
references.pmid: 16479429
references.citation: Endoscopy. 2001 Apr;33(4):353-7
references.pmid: 11315899
references.citation: Endoscopy. 2013;45 Suppl 2 UCTN:E71
references.pmid: 23526524
references.citation: Gastrointest Endosc. 2003 Nov;58(5):813-4
references.pmid: 14997904
references.citation: Endoscopy. 2012;44 Suppl 2 UCTN:E387
references.pmid: 23135974
references.citation: Gastrointest Endosc. 2011 Sep;74(3):573-80
references.pmid: 21802676
references.citation: Gastrointest Endosc. 1992 Sep-Oct;38(5):545-50
references.pmid: 1397908
references.citation: Am J Gastroenterol. 1988 Mar;83(3):283-6
references.pmid: 3278595
references.citation: J Am Coll Surg. 2003 Feb;196(2):290-6
references.pmid: 12595057
references.citation: Endoscopy. 1998 Sep;30(7):590-4
references.pmid: 9826135
references.citation: Gut. 1993 Oct;34(10):1418-21
references.pmid: 8244112
references.citation: Endoscopy. 2004 May;36(5):416-20
references.pmid: 15100950
references.citation: Endoscopy. 2003 May;35(5):388-92
references.pmid: 12701008
references.citation: J Laparoendosc Adv Surg Tech A. 2007 Aug;17(4):509-12
references.pmid: 17705738
references.citation: Aust N Z J Surg. 1984 Aug;54(4):337-9
references.pmid: 6333234