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

Core Tip

Core tip: Dieulafoy’s lesion is an important cause of acute gastrointestinal bleeding. Dieulafoy’s lesions maintain an abnormally large caliber despite their peripheral, submucosal, location. Dieulafoy’s lesions typically present with severe, active, gastrointestinal bleeding. About 75% of lesions are located in the stomach, most commonly close to the gastroesophageal junction, but lesions can occur in duodenum and esophagus. Endoscopy is the first diagnostic test (70% diagnostic yield). Lesions typically appear at endoscopy as pigmented protuberances from exposed vessel stumps, with minimal surrounding erosions. Endoscopic therapy, including clips, sclerotherapy, argon plasma coagulation, thermocoagulation, or electrocoagulation, is the recommended initial therapy, with primary hemostasis achieved in nearly 90% of cases. Mortality of bleeding from this lesion is 9%-13%.