Dieulafoy's disease.

Brisk bleeding from a Dieulafoy's gastric vascular anomaly is not an uncommon cause of upper gastrointestinal bleeding. The lesion in Dieulafoy's disease consists of a normal caliber artery that runs very close to the epithelial layers and is therefore relatively large compared with the vessels normally in that area. Meticulous inspection of the gastric mucosa, especially in the well-distended upper part of the stomach, is essential for an adequate diagnosis. Quite often multiple endoscopies are necessary before the lesion is recognized. In the past 10 years Dieulafoy's disease has also been described in almost every other part of the gastrointestinal tract, although less frequently than in the stomach. Endoscopy is the primary diagnostic technique but in some patients ES has been described to be of major help in identifying the vascular anomalies and in guiding local therapy aimed at occlusion of the abnormal vessel. Successful hemostasis has been reported with many different endoscopic techniques, with a success rate between 80% and 90% in expert hands. Alternatively, wedge resection or vascular ligation is required in cases of endoscopic failure at hemostasis. With further improvement of our diagnostic techniques, it is expected that even more patients will be diagnosed with Dieulafoy's disease in the future.