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Endoscopic Management of Dieulafoy’s Lesion

김광하|전혜경
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2015.03|Clinical Endoscopy|제48권 제2호|pp. 112-120

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참고문헌

키워드

Endoscopic treatmentGastrointestinal tractDieulafoy’s lesion
주제분류내과학

초록

A Dieulafoy’s lesion is a vascular abnormality consisting of a large caliber-persistent tortuous submucosal artery. A small mucosal defectwith the eruption of this protruding vessel can cause bleeding. In fact, a Dieulafoy’s lesion is a relatively rare but potentially life-threateningcondition. It accounts for 1% to 2% of cases of acute gastrointestinal bleeding. Although there is no consensus on the treatment ofDieulafoy’s lesions; treatment options depend on the mode of presentation, site of the lesion, and available expertise. Endoscopic therapyis usually successful in achieving primary hemostasis, with hemostasis success rates reaching 75% to 100%. Although various therapeuticendoscopic methods are used to control bleeding in Dieulafoy’s lesions, the best method for endoscopic intervention is not clear. Combination endoscopic therapy is known to be superior to monotherapy because of a lower rate of recurrent bleeding. In addition,mechanical therapies including hemostatic clipping and endoscopic band ligation are more effective and successful in controlling bleedingthan other endoscopic methods. Advances in endoscopic techniques have reduced mortality in patients with Dieulafoy’s lesion—from 80% to 8%—and consequently, the need for surgical intervention has been reduced. Currently, surgical intervention is used forcases that fail therapeutic endoscopic or angiographic interventions.

Abstract

A Dieulafoy’s lesion is a vascular abnormality consisting of a large caliber-persistent tortuous submucosal artery. A small mucosal defectwith the eruption of this protruding vessel can cause bleeding. In fact, a Dieulafoy’s lesion is a relatively rare but potentially life-threateningcondition. It accounts for 1% to 2% of cases of acute gastrointestinal bleeding. Although there is no consensus on the treatment ofDieulafoy’s lesions; treatment options depend on the mode of presentation, site of the lesion, and available expertise. Endoscopic therapyis usually successful in achieving primary hemostasis, with hemostasis success rates reaching 75% to 100%. Although various therapeuticendoscopic methods are used to control bleeding in Dieulafoy’s lesions, the best method for endoscopic intervention is not clear. Combination endoscopic therapy is known to be superior to monotherapy because of a lower rate of recurrent bleeding. In addition,mechanical therapies including hemostatic clipping and endoscopic band ligation are more effective and successful in controlling bleedingthan other endoscopic methods. Advances in endoscopic techniques have reduced mortality in patients with Dieulafoy’s lesion—from 80% to 8%—and consequently, the need for surgical intervention has been reduced. Currently, surgical intervention is used forcases that fail therapeutic endoscopic or angiographic interventions.

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