Dieulafoy lesion of the gastrointestinal tract: what's new? A narrative review.

Abstract

Dieulafoy's lesion is a rare but potentially life-threatening cause of gastrointestinal bleeding because of an abnormally dilated submucosal artery that erodes the overlying epithelium without a primary ulceration. Typically located in the proximal stomach near the esophagogastric junction, Dieulafoy's lesions can also occur throughout the whole gastrointestinal tract, including the oesophagus, small bowel, and colon. Rare cases have been reported in the respiratory tract. Dieulafoy's lesion accounts for approximately 3.5% of gastrointestinal bleeding cases, with mortality rates ranging from 23 to 79%, mainly because of the risk of rebleeding and surgical complications. The aetiology of Dieulafoy's lesion remains unclear, despite congenital vessel dilation and stress-induced factors have been invoked. Common symptoms include haematemesis, melena, and signs of acute arterial bleeding; nevertheless, the diagnosis is often challenging because of intermittent haemorrhage. Endoscopic examination typically reveals a pigmented protuberance without ulceration; however, excessive bleeding or small lesion size may hinder detection. Early endoscopy (within 12 h) significantly improves diagnostic accuracy. Therapeutic approaches may differ in relation to the presentation and lesion location. Endoscopic haemostasis is the preferred technique, achieving success in nearly 90% of cases. Haemostatic procedures include injective, thermal, and mechanical methods. Angiographic embolisation or surgery are limited in cases of endoscopic treatment failure. Advances in endoscopic therapy have reduced Dieulafoy's lesion-related mortality from 80 to 8.6%, despite rebleeding remains a concern. A multidisciplinary approach, combining endoscopy, radiology, and surgery when necessary, is crucial for optimal management, thus improving patient outcomes.