Therapeutic endoscopy for Dieulafoy's disease.

Dieulafoy's disease is an underdiagnosed cause of massive upper gastrointestinal bleeding. The mortality rate is extremely high and the diagnosis is usually made at autopsy. Operation has been deemed the treatment of choice for Dieulafoy's disease in the past decades. Here, however, we report successful therapeutic endoscopy in eight cases of Dieulafoy's disease in a period of 20 months. Six patients (75%) were in shock before therapy. Six received heat-probe thermocoagulation, one received pure alcohol (99.8%) injection and one received hypertonic glucose solution (50%) injection. No perforation or recurrent hemorrhage occurred in the following period of 11.2 +/- 3.4 months (SEM) in six patients. The other two died of unrelated illness. In the near future, therapeutic endoscopy may replace surgery in the management of Dieulafoy's disease.