Management of Dieulafoy’s Lesions

Dieulafoy’s lesion is a difficult-to-diagnose, potentially life-threatening gastrointestinal bleeding condition. It is a vascular abnormality that consists of a large caliber-persistent tortuous artery with no apparent pathology but a small mucosal defect that resulted in eruption. The cause of the actual rupture is not clearly understood. The diagnostic modality of choice is endoscopy, primarily for its concomitant treatment possibilities. There is no general consensus on treatment of Dieulafoy’s lesion, but, as in diagnosis, endoscopy emerged as the preferred mode for management. Endoscopic treatments are organized into three groups’injection, mechanical, thermal; combined treatments are preferred to monotherapy as the success rate is higher. Due to recent advances in interventional radiology, angiography became the second choice of treatment for Dieulafoy’s lesion. Although in the past surgery was common in management of this condition, its role has been reduced for only the cases that failed under the first two modalities.