Hemostasis of Dieulafoy's lesions by argon plasma coagulation (with video)

Background A Dieulafoy's lesion is a submucosal artery that may erode the epithelium and lead to severe hemorrhages. The safety and efficacy of argon plasma coagulation (APC) for the hemostasis of these lesions has not been studied. Objective To evaluate efficacy of APC alone in the hemostasis of Dieulafoy's lesions. Design A retrospective analysis of hemostasis by chart review, with long-term follow-up by outpatient visit or phone interview. Setting An academic hospital with 24-hour endoscopic service availability. Patients All patients with acute bleeding from a Dieulafoy's lesion treated with APC. Interventions Hemostasis was attempted with 2.3-mm APC probes, with settings varying from 40 W to 60 W, according to lesion location. Main Outcome Measurements Initial hemostasis, recurrent bleeding, and 30-day mortality rates. Results Twenty-three Dieulafoy's lesions were treated with APC, which represented 85% of all such lesions observed. Severe comorbidities and abnormal coagulation were present in 39% and 22%, respectively. Dieulafoy's lesions were located in the upper-GI tract in 20 patients (87%). Active bleeding was found in 20 patients (87%), a nonbleeding visible vessel was found in 2 patients (9%), and a minute mucosal defect below an adherent clot was found in 1 (4%). Initial hemostasis was achieved in all patients, without complications. An injection of an average volume of 3 mL of 1:10,000 epinephrine solution preceded APC in 3 cases for the identification of the bleeding lesion. Recurrent bleeding occurred in a patient after 48 hours; no bleeding-related deaths were observed during a median follow-up of 29 months. Limitations Retrospective study. Conclusions Dieulafoy's lesions can be successfully managed by APC alone.