Background and Aims
We sought to determine the incidence, risk factors, and treatment outcomes of Dieulafoy’s
lesion of the upper GI tract (UDL) hemorrhage among adult patients in the United States.
Methods
UDL and non-Dieulafoy upper GI bleeding (UGIB) were identified from the Nationwide
Inpatient Sample and Nationwide Readmission Database using International Classification
of Diseases, Tenth Revision, Clinical Modification and Procedure Coding System codes.
Multivariate logistic (binary) and linear (continuous) regressions were used to model
dependent variables.
Results
The incidence of UDL hemorrhage was 1.6 of 100,000 persons. Patients with UDL and
UGIB who required endoscopic therapeutic intervention had similar in-hospital (adjusted
odds ratio [aOR], .77; 95% confidence interval [CI], .42-1.43; P = .41) mortality rates. UDL was associated with more severe systemic illness, including
higher rates of mechanical ventilation (aOR, 1.52; 95% CI, 1.07-2.15; P < .05), hypovolemic shock (aOR, 1.50; 95% CI, 1.08-2.08; P < .05), acute kidney injury (aOR, 1.25; 95% CI, 1.02-1.54; P < .05), and multiple endoscopies (aOR, 1.57; 95% CI, 1.28-1.93; P < .05) compared with other UGIB patients who required endoscopic therapeutic intervention.
UDL was also associated with higher 30-day all-cause (aOR, 1.23; 95% CI, 1.12-1.35;
P < .05) and recurrent bleeding-related (aOR, 1.73; 95% CI, 1.45-2.06; P < .05) readmissions. The rate of successful endoscopic treatment was 96.81%.
Conclusions
UDL hemorrhage is an uncommon but highly morbid condition. Current UDL treatment modalities
are effective in reducing mortality. Further investigations are warranted to lower
recurrent bleeding rates.
Graphical abstract
Graphical Abstract
Abbreviations:
aOR (adjusted odds ratio), CI (confidence interval), DL (Dieulafoy's lesion), ICD-10-CM/PCS (International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System), LOS (length of stay), NIS (Nationwide Inpatient Sample), NRD (Nationwide Readmission Database), NSAID (nonsteroidal anti-inflammatory drug), OR (odds ratio), RBC (red blood cells), UDL (Dieulafoy's lesion of the upper GI tract), UGIB (upper GI bleeding)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Georges-Paul Dieulafoy (1839-1911) and the first description of “exulceratio simplex.”.Ann Gastroenterol. 2011; 24: 188-191
- The pathogenesis of Dieulafoy’s gastric erosion.Am J Gastroenterol. 1984; 79: 195-200
- Recurrent massive haematemesis from Dieulafoy vascular malformations—a review of 101 cases.Gut. 1986; 27: 213-222
- Dieulafoy’s disease.J Am Coll Surg. 2003; 196: 290-296
- Dieulafoy’s lesion.Gastrointest Endosc. 2003; 58: 236-243
- Dieulafoy-like lesion of the rectum presenting with exsanguinating hemorrhage: successful endoscopic sclerotherapy.Am J Gastroenterol. 1993; 88: 1939-1941
- Dieulafoy-like lesion of the distal esophagus.Am J Gastroenterol. 1994; 89: 2080-2081
- Dieulafoy lesions of the GI tract: localization and therapeutic outcomes.Dig Dis Sci. 2010; 55: 3436-3441
- Bleeding from the endoscopically-identified Dieulafoy lesion of the proximal small intestine and colon.Am J Gastroenterol. 1995; 90: 108-111
- Bleeding Dieulafoy lesions of the small bowel: a systematic study on the epidemiology and efficacy of enteroscopic treatment.Gastrointest Endosc. 2011; 74: 573-580
- Dieulafoy’s lesion: current trends in diagnosis and management.Ann R Coll Surg. 2010; 92: 548-554
- Endoscopic band ligation of a Dieulafoy lesion in the small intestine of a child.Gastrointest Endosc. 1996; 44: 336-339
- Dieulafoy lesion in a one-year-old child.J Pediatr Surg. 2004; 39: 133-134
- Gastrointestinal endoscopy: past and future.Gut. 2005; 55: 1061-1064
- Dieulafoy’s disease: endoscopic treatment and follow up.Gut. 1993; 34: 1418-1421
- Endoscopic management of Dieulafoy lesions of the stomach: a case study of 26 patients.Endoscopy. 1997; 29: 834-839
- Management and long-term prognosis of Dieulafoy lesion.Gastrointest Endosc. 1999; 50: 762-767
- Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: a nationwide analysis.Dig Dis Sci. 2018; 63: 1286-1293
- Healthcare Cost and Utilization Project (HCUP). 2016-2017. Rockville, MD: Agency for Healthcare Research and Quality.(Available at:)https://www.hcup-us.ahrq.gov/nisoverview.jspDate accessed: May 18, 2020
- Healthcare Cost and Utilization Project (HCUP). 2016-2017. Rockville, MD: Agency for Healthcare Research and Quality.(Available at:)www.hcup-us.ahrq.gov/nrdoverview.jspDate accessed: May 18, 2020
Zhao Y, Encinosa W. Hospitalizations for gastrointestinal bleeding in 1998 and 2006: statistical brief #65. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality (US); December 2008.
- Regression methods in biostatistics: linear, logistic, survival, and repeated measures models (statistics for biology and health).2nd ed. New York: Springer, 2012
- CHARLSON: Stata module to calculate Charlson index of comorbidity.Stat Softw Components. 2006; : S456719
- (Available at:)https://www.census.gov/programs-surveys/popest/data/tables.htmlDate accessed: March 23, 2020
- Dieulafoy lesions: a review of 6 years of experience at a tertiary referral center.Am J Gastroenterol. 2001; 96: 1688-1694
- Dieulafoy’s lesion—diagnosis and management.Dig Dis Sci. 1991; 36: 1702-1707
- Endoscopic management and long-term follow-up of Dieulafoy’s lesions in the upper GI tract.Gastrointest Endosc. 2002; 55: 527-531
- Gastrointestinal bleeding from Dieulafoy’s lesion: clinical presentation, endoscopic findings, and endoscopic therapy.World J Gastrointest Endosc. 2015; 7: 295
- The influence of body mass index on mortality and bleeding among patients with or at high-risk of atherothrombotic disease.J Vasc Surg. 2009; 50: 1242-1243
- Body mass index and bleeding complications after percutaneous coronary intervention: Does bivalirudin make a difference?.Am Heart J. 2010; 159: 1139-1146
- Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use.Thromb Haemost. 2003; 89: 493-498
- Associations of haemostatic variables with body mass index.Blood Coagul Fibrinolysis. 2003; 14: 569-573
- The VITA project: phenotypic resistance to activated protein C and FV Leiden mutation in the general population. Vicenza Thrombophilia and Atherosclerosis.Thromb Haemost. 1997; 78: 859-863
- Abdominal obesity is associated with an impaired fibrinolytic activity and elevated plasminogen activator inhibitor-1.Metabolism. 1990; 39: 1044-1048
- Association between obesity and a prothrombotic state: the Framingham Offspring Study.Thromb Haemost. 2004; 91: 683-689
- Endoscopic treatment of Dieulafoy's disease.Gastroenterology. 1988; 94: 563-566
- Bleeding Dieulafoy's lesions and the choice of endoscopic method: comparing the hemostatic efficacy of mechanical and injection methods.Gastrointest Endosc. 2000; 52: 721-724
- Arterial embolization of a bleeding gastric Dieulafoy lesion: a case report.Clin Ter. 2013; 164: 25-27
- Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease.Gastrointest Endosc. 2010; 71: 44-49
- Chronic kidney disease severely deteriorates the outcome of gastrointestinal bleeding: a meta-analysis.World J Gastroenterol. 2017; 23: 8415-8425
- Clinical outcomes and risk factors of rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage.Clin Endosc. 2011; 44: 93
- Continuation of low-dose aspirin therapy in peptic ulcer bleeding.Ann Intern Med. 2010; 152: 1
- Nonlocalized lower gastrointestinal bleeding: provocative bleeding studies with intraarterial tPA, heparin, and tolazoline.J Vasc Interv Radiol. 2001; 12: 1273-1277
- Use of anticoagulation during wireless capsule endoscopy for the Investigation of recurrent obscure gastrointestinal bleeding.Endoscopy. 2006; 38: 526-528
- Emerging role of thalidomide in the treatment of gastrointestinal bleeding.Frontline Gastroenterol. 2018; 9: 98-104
- Pharmacological therapy of vascular malformations of the gastrointestinal tract.Can J Gastroenterol. 2006; 20: 171-178
- The accuracy of diagnosis and procedural codes for patients with upper GI hemorrhage.Gastrointest Endosc. 2000; 51: 423-426
Article info
Publication history
Published online: December 23, 2020
Accepted:
December 3,
2020
Received:
October 7,
2020
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
