Dieulafoy's lesion: How is it treated?

Dieulafoy's lesion is an abnormality in a small artery that supplies blood to the gastrointestinal tract, usually in the stomach. In Dieulafoy's lesion, the artery doesn't branch out properly, causing it to become up to 10 times its normal diameter and to erode the vascular lining (epithelium). This results in bleeding into the gastrointestinal tract. Although the cause isn't known, it occurs most often in middle-aged men.

Dieulafoy's lesion is an uncommon cause of severe gastrointestinal bleeding that requires emergency treatment. Signs and symptoms of bleeding depend on where the lesion is located but may include:

• Vomiting blood
• Bloody or black, tarry stools
• Dizziness or lightheadedness

A doctor may locate the bleeding with endoscopy. In this procedure, a thin, flexible tube with a camera attached is inserted through your mouth or anus, which allows the doctor to see inside your stomach or colon. Treatment of a bleeding Dieulafoy's lesion may include:

• Medications injected directly into the lesion through an endoscope
• Endoscopic procedures to seal the lesion, such as with heat (cauterization), surgical clips, rubber bands or lasers
• Reducing blood flow to the affected artery (embolization) guided by X-ray images of the blood vessels (angiography)
• Rarely, surgical removal of the lesion. Typically, surgery is recommended only if other treatment options haven't been successful.

Recurrence of gastrointestinal bleeding due to Dieulafoy's lesion is common. However, endoscopic procedures can be repeated to increase the likelihood of clotting.