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[Endoscopic sclerotherapy is useful in Dieulafoy's disease ]
J A Ortuño-Cortés1, L Quintana-Tomás, A García-García
1Unidad de Gastroenterologia, Hospital General de Area de Elda, Alicante.
Insights
Dieulafoy disease is a rare but serious cause of upper digestive bleeding, primarily affecting older males. Endoscopic sclerotherapy with polidocanol offers an effective and safe treatment option.
Area of Science:
- Gastroenterology
- Endoscopy
- Vascular Lesions
Background:
- Dieulafoy disease is an uncommon cause of upper gastrointestinal bleeding.
- It is characterized by an abnormally large artery eroding into the gastrointestinal tract.
- Diagnosis and management can be challenging.
Purpose of the Study:
- To retrospectively analyze the clinical characteristics, diagnostic methods, and treatment outcomes of patients with Dieulafoy disease.
- To evaluate the efficacy and safety of endoscopic sclerotherapy for Dieulafoy disease.
Main Methods:
- Retrospective analysis of 14 patients with Dieulafoy disease over 74 months.
- Review of clinical histories, endoscopic findings, and treatment interventions.
- Focus on endoscopic sclerotherapy with polidocanol, sometimes preceded by adrenaline injection.
Main Results:
- Dieulafoy disease accounted for 1.18% of non-varicose upper digestive hemorrhages.
- Observed male predominance (6:1) and advanced age (median 67.5 years).
- Endoscopic sclerotherapy achieved definitive hemostasis in 78% of patients; 2 required surgery, and 1 died.
Conclusions:
- Dieulafoy disease is an infrequent yet severe cause of digestive hemorrhage, predominantly in males over 50.
- Repeated endoscopy is often necessary for diagnosis and treatment.
- Endoscopic sclerotherapy with polidocanol is effective and safe, though surgery and mortality are possible.
Abstract:
The clinical histories of 14 patients with digestive hemorrhage due to Dieulafoy disease admitted to the authors' hospital over 74 months were retrospectively analyzed. These cases represent 1.18% of the non varicose upper digestive hemorrhages (CI 95%; 0.57-1.79%). Male predominance (6:1) and advanced age (median: 67.5 years) were observed. The ingestion of potentially gastroerosive drugs, smoking and alcoholism were reported in 57, 57 and 7% of the cases, respectively. Six patients (43%) required more than one endoscopy for diagnosis. The lesion responsible for hemorrhage was found at 6 cm or less from the cardias on 11 occasions (78%). Endoscopic sclerotherapy was performed in the vessel by polidocanol at 2% (1.5-10 ml, median: 6). In 10 cases sclerotherapy was preceded by the injection of adrenaline 1/10,000 (2-11 ml, median: 5). Definitive hemostasis was achieved in 11 patients (78%) (two of these cases required further sclerotherapy); 2 patients required surgery, and one patient (7%) died. Of the 13 surviving patients, none presented relapse after follow up of 2-63 months. We can conclude that Dieulafoy disease is an infrequent but severe cause of digestive hemorrhage, being predominantly found in males over the age of 50 years. Repeated endoscopy is often required to determine diagnosis and treatment. Endoscopic sclerotherapy with polidocanol is effective and safe in this disease although surgery may be required and death may occur.