Gastrointestinal bleeding from Dieulafoy’s lesion: Clinical presentation, endoscopic findings, and endoscopic therapy

Table 1 Clinico-epidemiologic characteristics of Dieulafoy lesion

Anatomy

Dilated, aberrant, submucosal artery eroding overlying gastrointestinal mucosa in absence of either underlying ulcer or local aneurysm

Location

70% of ulcers in stomach

In stomach most commonly located within 6 cm of gastroesophageal junction along lesser curve

Can occur moderately commonly in esophagus or duodenum, occasionally in jejunum or ileum, and rarely in colon

Epidemiology

Generally presents clinically in older age, but can occur at any age

Male:female ratio = 2:1

No known epidemiologic risk factors or clinically associated diseases

Clinical presentation

Typically presents with overt GI bleeding, often with hematemesis or melena, or both

Bleeding typically severe

No prodromal symptoms

Typically bleeding is painless

Frequent presentation with signs or laboratory tests of hemodynamic instability, including: tachycardia, hypotension, orthostasis, and acute prerenal azotemia

Frequently requires transfusion of multiple units of packed erythrocytes

Frequent recurrent bleeding if undetected or not treated at initial endoscopy

GI: Gastrointestinal.