Upper GI endoscopy is performed on a patient with recurrent small upper GI bleeding episodes. A lesion is seen in the stomach that is characterized as a bleeding vessel. Dieulafoy’s lesion of the stomach is suspected. This lesion is characterized by:
|A||A large mucosal defect with underlying friable vascular plexus|
|B||Frequent rebleeding after endoscopic treatment|
|C||Massive bleeding that requires subtotal gastrectomy|
|D||Location in the proximal stomach|
a. Dieulafoy's lesions are vascular malformations found primarily along the lesser curve of the stomach within 6 cm of the gastroesophageal junction, although they can occur elsewhere in the GI tract.
b. Erosion of the gastric mucosa overlying these vessels leads to hemorrhage.
c. The mucosal defect is usually small (2-5 mm) and may be difficult to identify. Given the large size of the underlying artery, bleeding from a Dieulafoy's lesion can be massive.
d. Application of thermal or sclerosant therapy is effective in 80% to 100% of cases.
e. In cases that fail endoscopic therapy, angiographic coil embolization can be successful.
f. If these approaches fail, surgical intervention may be necessary; owing to difficulties in visualization and palpation of these lesions, prior endoscopic tattooing can facilitate the procedure.
g. In cases in which the bleeding point is not identified, a partial gastrectomy may be necessary.