[Clinical aspects and endoscopic management of gastrointestinal bleeding from Dieulafoy's lesion]. / Aspectos clínicos y tratamiento endoscópico de la hemorragia digestiva por lesión de Dieulafoy.

OBJECTIVE: the aim of the study was to assess the incidence, clinical presentation, location, and response to endoscopic therapy of gastrointestinal bleeding from Dieulafoy's lesion. MATERIAL AND METHOD: ALL consecutive episodes of gastrointestinal bleeding due to Dieulafoy's lesion seen between 2000 and 2006 were retrospectively reviewed. All main clinical and endoscopic data were collected: type and effectiveness of endoscopic therapy, rebleeding, complications, and mortality during hospitalization. RESULTS: WE found 41 patients, 26 males and 15 females, median age of 71.19 years. Dieulafoy's lesion accounted for 1.55% of all gastrointestinal bleeding episodes during the study period. The incidence of Dieulafoy's lesion was 2.2 cases/100.000 inhabitants/year. Active bleeding at endoscopy was present in 85.36%, and comorbidity in 92.68%. The stomach was the most frequent location (60.97%), followed by duodenum (29.26%). Endoscopic therapy achieved initial hemostasis in all cases. Three patients (7.31%) initially treated with epinephrine injection showed rebleeding and properly responded to a second session of endoscopic therapy. No surgery was needed. The mortality rate during hospitalization was 4.87%. CONCLUSIONS: Dieulafoy's lesion is an uncommon, but potentially severe cause of gastrointestinal bleeding. It may be found in any location within the gastrointestinal tract. Endoscopic therapy is effective and safe. Injected epinephrine alone is associated with a higher risk of rebleeding.

Aspectos clínicos y tratamiento endoscópico de la hemorragia digestiva por lesión de Dieulafoy / Clinical aspects and endoscopic management of gastrointestinal bleeding from Dieulafoy's lesion

Objetivo: conocer la incidencia, forma de presentación, localizacióny resultados del tratamiento endoscópico en la hemorragiadigestiva causada por lesión de Dieulafoy.Material y métodos: se revisaron de forma retrospectiva todoslos casos de hemorragia digestiva por lesión de Dieulafoy entrelos años 2000 y 2006. Se recogieron los principales datos clínicosy endoscópicos, tipo de tratamiento empleado, eficacia delmismo, recidiva, complicaciones y mortalidad durante el ingreso.Resultados: se encontraron 41 pacientes, 26 varones y 15mujeres, con edad media de 71,19 años. La lesión de Dieulafoyfue la causa del 1,55% de los casos de hemorragia digestiva agudaen el periodo estudiado. La incidencia de hemorragia digestivapor lesión de Dieulafoy fue de 2,2 casos por cada 100.000 habitantesy año. La mayoría de los pacientes presentaban hemorragiaactiva en el momento de la endoscopia (85,36%) y comorbilidad(92,68%). La localización más frecuente fue el estómago(60,97%), seguida del duodeno (29,26%). El tratamiento endoscópicologró la hemostasia inicial en el 100% de los casos. Trespacientes (7,31%) presentaron recidiva hemorrágica, todos elloshabían sido tratados inicialmente con esclerosis con adrenalina yrespondieron adecuadamente a un segundo tratamiento endoscópico.Ningún paciente precisó cirugía. La mortalidad durante elingreso fue del 4,87%.Conclusiones: la lesión de Dieulafoy es una causa poco frecuente,pero potencialmente grave, de hemorragia digestiva ypuede aparecer en cualquier punto del tracto gastrointestinal. Eltratamiento endoscópico es eficaz y presenta pocas complicaciones.La esclerosis única con adrenalina se asocia a un mayor riesgode recidiva hemorrágica

Objective: the aim of the study was to assess the incidence,clinical presentation, location, and response to endoscopic therapyof gastrointestinal bleeding from Dieulafoy’s lesion.Material and methods: all consecutive episodes of gastrointestinalbleeding due to Dieulafoy’s lesion seen between 2000 and2006 were retrospectively reviewed. All main clinical and endoscopicdata were collected: type and efectiveness of endoscopictherapy, rebleeding, complications, and mortality during hospitalization.Results: we found 41 patients, 26 males and 15 females, medianage of 71.19 years. Dieulafoy’s lesion accounted for 1.55%of all gastrointestinal bleeding episodes during the study period.The incidence of Dieulafoy’s lesion was 2.2 cases/100.000 inhabitants/year. Active bleeding at endoscopy was present in85.36%, and comorbidity in 92.68%. The stomach was the mostfrequent location (60.97%), followed by duodenum (29.26%). Endoscopictherapy achieved initial hemostasis in all cases. Threepatients (7.31%) initially treated with epinephrine injectionshowed rebleeding and properly responded to a second session ofendoscopic therapy. No surgery was needed. The mortality rateduring hospitalization was 4.87%.Conclusions: Dieulafoy’s lesion is an uncommon, but potentiallysevere cause of gastrointestinal bleeding. It may be found inany location within the gastrointestinal tract. Endoscopic therapyis effective and safe. Injected epinephrine alone is associated witha higher risk of rebleeding