Bleeding from the Endoscopically-identified Dieulafoy Lesion of the Proximal Small Intestine and Colon

Objectives: Our goal was to assess the incidence of the endoscopically-identified small intestinal and colonic Dieulafoy-like lesions in our GI bleeding population and to characterize the clinical and endoscopic features and response to endoscopic therapy.

Methods: Patients with GI bleeding from Dieulafoy lesions were identified from our Bleeding Team and GI laser data bases from August 1984 to September 1993. Clinical and endoscopic information contained within the data bases and from each patient's medical record were retrospectively reviewed. Diagnostic criteria that had been used to endoscopically diagnose a Dieulafoy lesion were arterial bleeding or nonbleeding visible vessel stigmata, all without ulceration or erosion.

Results: Nine patients (three male; six female; median age, 70 yr; range, 16-94) were identified from a population of 3059 patients. Symptoms included: melena (2); hematochezia (7); and unstable hemodynamics (3). The mean hemoglobin was 8.4 +/- 2.2 g/dl. There was no significant nonsteroidal antiinflammatory drug or alcohol use. Four patients had small bowel and five patients had colonic Dieulafoy's lesions. Specific sites were: distal duodenum (3); jejunum (1); cecum (1); hepatic flexure (3); and transverse colon (1). The diagnosis was made at initial endoscopy in seven patients, after two endoscopies in one patient, and after four in another patient. Active bleeding was encountered in seven patients (three small bowel; four colon). Endoscopic therapy was successful. Two patients rebled, one from the same site (small bowel) 1 yr later. Both were successfully retreated. There were no complications or deaths.

Conclusions: The endoscopic Dieulafoy lesion of the small bowel and colon is infrequently encountered. The diagnosis is most often made during active bleeding. The endoscopic diagnosis requires an aggressive approach, including repeated endoscopy. Endoscopic therapy of proximal small intestinal and colonic Dieulafoy lesions is safe, effective, and should be performed.