Mariana Brito1,2, Gonçalo Nunes1,2, Pedro Pinto Marques1, Manuela Canhoto1, Ana Luísa Proença3, Jorge Fonseca1,2. 1. Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal. 2. PaMNEC - Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de investigação interdisciplinar Egas Moniz, Monte da Caparica, Portugal. 3. Radiology Department, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal.
Abstract
INTRODUCTION: Dieulafoy's lesion (DL) is a rare but important cause of acute, severe, life-threatening, and recurrent upper gastrointestinal bleeding (UGIB). It is frequently difficult to diagnose DL with upper GI endoscopy (UGIE), and endoscopic ultrasonography (EUS) may be valuable. There are only 2 reported bleeding cases caused by two synchronous DL but no reported cases of two metachronous DL. CASE REPORT: A 28-year-old healthy male presented with acute severe UGIB. UGIE was inconclusive. Systematic EUS mapping identified a gastric DL. After several attempts of EUS-guided hemostasis, DL was marked using a through-the-scope clip and the patient underwent successful transcatheter arterial embolization (TAE). Three years later, a new severe UGIB episode was caused by a second gastric DL in a different location, which was identified and marked by EUS and further successfully treated through TAE. The patient maintained follow-up without evidence of further bleeding. DISCUSSION/ CONCLUSION: The authors report a unique case of severe, recurrent UGIB caused by two metachronous gastric DL lesions. The importance of systematic EUS scanning for diagnosis, treatment, and follow-up of DL is emphasized, as well as the potential influence in the outcome of other techniques like angiographic embolization.
INTRODUCTION: Dieulafoy's lesion (DL) is a rare but important cause of acute, severe, life-threatening, and recurrent upper gastrointestinal bleeding (UGIB). It is frequently difficult to diagnose DL with upper GI endoscopy (UGIE), and endoscopic ultrasonography (EUS) may be valuable. There are only 2 reported bleeding cases caused by two synchronous DL but no reported cases of two metachronous DL. CASE REPORT: A 28-year-old healthy male presented with acute severe UGIB. UGIE was inconclusive. Systematic EUS mapping identified a gastric DL. After several attempts of EUS-guided hemostasis, DL was marked using a through-the-scope clip and the patient underwent successful transcatheter arterial embolization (TAE). Three years later, a new severe UGIB episode was caused by a second gastric DL in a different location, which was identified and marked by EUS and further successfully treated through TAE. The patient maintained follow-up without evidence of further bleeding. DISCUSSION/ CONCLUSION: The authors report a unique case of severe, recurrent UGIB caused by two metachronous gastric DL lesions. The importance of systematic EUS scanning for diagnosis, treatment, and follow-up of DL is emphasized, as well as the potential influence in the outcome of other techniques like angiographic embolization.
Authors: Louis-Michel Wong Kee Song; Subhas Banerjee; Bradley A Barth; Yasser Bhat; David Desilets; Klaus T Gottlieb; John T Maple; Patrick R Pfau; Douglas K Pleskow; Uzma D Siddiqui; Jeffrey L Tokar; Amy Wang; Sarah A Rodriguez Journal: Gastrointest Endosc Date: 2012-03-23 Impact factor: 9.427
Authors: Ryan Law; Larissa Fujii-Lau; Louis M Wong Kee Song; Christopher J Gostout; Patrick S Kamath; Barham K Abu Dayyeh; Ferga C Gleeson; Elizabeth Rajan; Mark D Topazian; Michael J Levy Journal: Clin Gastroenterol Hepatol Date: 2014-09-19 Impact factor: 11.382