Post written by Yichen Wang, MD, MSc, from the Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA.
We sought to determine the incidence, risk factors, and treatment outcomes of Dieulafoy’s lesion of the upper GI tract (UDL) hemorrhage among adult patients in the United States.
Dieulafoy’s lesion is an aberrantly large artery that did not undergo normal blanching within the walls of the stomach, without signs of aneurysms, arteriosclerosis, or vasculitis are generally absent. Because of the proximity of the arterial wall to the GI luminal cavity, only separated by a thin mucosal layer, a shallow erosion can result in massive and potentially fatal bleeding. Increased hospitalizations for Dieulafoy’s lesion in recent years have been reported. However, to date, no study has examined this rare but potentially deadly cause of GI hemorrhage at the national level. Although many case reports and a few case series and reviews have provided insights on the epidemiologic characteristic and clinical course of DL, these studies have relatively small sample sizes, which makes generating statistical confidence challenging and limits the generalizability of the results obtained.
We found hemorrhage from Dieulafoy’s lesion of the upper GI tract is uncommon and constitutes 1% to 2% of all upper GI hemorrhage admissions in the United States. Patients with hemorrhage from DL are older and have higher frequency of chronic kidney disease, heart failure, liver cirrhosis, and anticoagulation or antiplatelet agents use compared with patients with upper GI hemorrhage from other etiologies. Hemorrhage from Dieulafoy’s lesion of the upper GI tract was associated with more severe hemodynamic compromise, most likely because of poor hemodynamic reserve. The hemorrhage itself seems to be amenable to endoscopic hemostasis in most of cases (96.81%). A total of 1.52% of patients admitted for UDL who had endoscopic treatment required arterial embolization, which seems to be effective and safe. Surgery was not observed in our study in this setting. Although the in-hospital mortality rate was comparable with those of upper GI hemorrhage from other etiologies, DL hemorrhage was associated with higher 30-day all-cause and hemorrhage related readmission. We identified end-stage renal disease as a non-endoscopic independent predictor of readmission.
Figure 3. Predictors for occurrence of Dieulafoy’s lesion of the upper GI tract. Numbers demonstrate adjusted odds ratio (95% confidence interval), P value. Predictors were adjusted against each other and the following additional potential confounders (not displayed in the figure): race, median household income in the patient’s zip code, whether admission is on a weekday or weekend, hospital region, hospital urban vs rural location, hospital teaching status, and hospital bed size.
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