Dieulafoy's lesion

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Dieulafoy's lesion is an uncommon cause of gastric bleeding thought to cause less than 5% of all gastro-intestinal bleeds in adults. It was named after French surgeon Paul Georges Dieulafoy who described this condition in his paper "Exulceratio simplex: Leçons 1-3" in 1898. Dieulafoy's Lesions bleed into the gastro-intestinal tract from an arteriole protruding through a minute defect in the mucosa. 95% of Dieulafoy's lesions occur in the upper part of the stomach, within 6cm of the gastro-oesophageal junction, however they can occur anywhere in the GI tract. Interestingly and in contrast to peptic ulcer disease, a history of alcohol abuse or NSAID use is usually absent in Dieulafoy's.

The symptoms due to bleeding are haematemesis and/or malaena, possibly with shock. It is diagnosed and treated endoscopically, however endoscopic ultrasound of angiography can be of benefit.

Endoscopic techniques used in the treatment include epinephrine injection followed by bipolar electrocoagulation, monopolar electrocoagulation, injection sclerotherapy, heater probe, laser photocoagulation, haemoclipping or banding.

The mortality rate for Dieulafoy's was much higher before the era of endoscopy, where open surgery was the only treatment option.