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Dieulafoy's lesion: an overview.

A I Joarder1, M S Faruque, M Nur-E-Elahi

  • 1Dr Aminul Islam Joarder, Assistant Professor, Department of Surgery, Bangbandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.

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Summary

Dieulafoy's lesion is a significant cause of acute gastrointestinal bleeding, often requiring multiple endoscopic procedures for diagnosis. Advances in diagnostic and therapeutic tools have dramatically reduced mortality rates.

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Area of Science:

  • Gastroenterology
  • Gastrointestinal Endoscopy
  • Hemorrhage Management

Background:

  • Dieulafoy's lesion is an uncommon but significant cause of acute upper and lower gastrointestinal bleeding.
  • Estimates suggest it accounts for 1-5.8% of upper GI bleeding cases and up to 40% of non-ulcer, non-variceal upper GI bleeding.

Purpose of the Study:

  • To review the incidence, diagnosis, and management of Dieulafoy's lesions.
  • To highlight the impact of recent advancements on patient outcomes.

Main Methods:

  • Review of retrospective and prospective studies on Dieulafoy's lesion.
  • Analysis of diagnostic modalities including endoscopy, angiography, and red cell scanning.
  • Evaluation of therapeutic strategies: endoscopic, angiographic, and surgical interventions.

Main Results:

  • Dieulafoy's lesions are diagnosed in 1.2-3.4% of acute GI bleeding cases via endoscopy.
  • Initial endoscopy diagnoses up to 70% of cases, with some requiring multiple procedures.
  • Therapeutic endoscopy and angiography are primary treatment options; surgery is reserved for refractory cases.
  • Mortality has decreased from 80% to 8.6% due to improved diagnostic and therapeutic tools.

Conclusions:

  • Dieulafoy's lesion is an important cause of GI bleeding, with diagnosis and treatment evolving.
  • Advancements in endoscopic and interventional techniques have significantly improved patient survival rates.
  • Continued research and refinement of diagnostic and therapeutic strategies are crucial.