Dieulafoy's lesion is a gastrointestinal submucosal artery that
ruptures into the lumen causing massive
hemorrhage. Until recently, failure to diagnose and treat patients endoscopically may have necessitated blind
gastrectomy. Because arteriolar spider
nevi abound in patients with
liver disease and
bleeding from such lesions has been described in the upper gastrointestinal tract, we reviewed our experience to determine whether a diagnosis of advanced
liver disease could facilitate recognition and treatment of this type of arterial
bleeding. Endoscopy records from 1991 to 1996 for all cases of upper gastrointestinal
bleeding at our institution were reviewed. Dieulafoy's lesion-like
bleeding was defined as arterial-type
bleeding with no evidence of mucosal ulceration or erosions. Advanced
liver disease was defined as signs of
portal hypertension and/or
cirrhosis or infiltrative
liver disease. Dieulafoy's lesion-like
bleeding was the cause in 6 of 4569 cases (0.13%). Five patients with Dieulafoy's lesion-like
gastrointestinal hemorrhage had advanced
liver disease compared with 954 of 4569 of all patients endoscoped for
gastrointestinal hemorrhage for the period evaluated (OR = 19.04; 95% CI 2.1-900.8; p < 0.002 by Fisher's exact test). Dieulafoy's lesion-like
bleeding was treated successfully with
epinephrine injection and endoscopic
cauterization in 5 of 6 patients with 1 patient requiring surgery. No other clinical associations were evident. Dieulafoy's lesion-like
bleeding occurs more commonly in patients with advanced
liver disease and should be included as a potential cause for
bleeding in advanced
liver disease and aggressively sought.